Gastric varices without portal hypertension: role of left inferior vena cava?

A variant vascular anatomy was detected during regular analysis of multidetector computed tomography angiography of the abdomen in a 70 year-old female patient, referred to the department of surgery for laparoscopic right colectomy for colon cancer. The anomalous vessel was located left to the aorta, and was consistent with a persistent left inferior vena cava. It was connected by two retroaortic rootlets to the dorsal surface of the regular right inferior vena cava and had four notable tributaries - an anastomosis with the iliolumbar trunk, ovarian vein, renal vein and the inferior phrenic vein. In the upper abdomen, the left inferior vena cava took a tortuous course, passing at first between the spleen and the diaphragm, then curving below the inferior splenic border and terminating in an irregular network in the posterior region of gastric fundus and cardia, close to the splenic hilum, without supradiaphragmatic continuation. Despite this extraordinary termination, there were no signs of portal hypertension or data on previous occurrence of this condition.