Intrahepatic portosystemic venous shunts are rare vascular anomalies that may be detected in asymptomatic patients, given the recent advances in radiological imaging techniques. Accurate shunt evaluation and classification can be performed with ultrasound and multi-detector computed tomography. We report an unusual case of an intrahepatic portosystemic venous shunt with an incidental finding of neurofibroma.

A 16-year-old girl with no past medical or surgical history presented with a 3-month history of abdominal pain and distension with weight loss. Computerised tomography (CT) scans (Figs 1 and 2) of the abdomen revealed a well-defined heterogeneous intraluminal gastric mass with interspersed air bubbles conforming to the shape of the stomach. No further intestinal lesions were noted. A diagnosis of gastric bezoar was made. A trichobezoar was confirmed on endoscopy, with subsequent successful surgical removal. A history of trichophagia was elicited post-surgery and the patient was subsequently referred for psychiatric evaluation and supportive psychotherapy to treat the impulse control disorder and prevent bezoar recurrence.

No abstract