Laparoscopically disclosed findings of insidious portal hypertension in a hepatitis B surface antigen carrier.

In a 37 year-old male, a chronic asymptomatic carrier, laparoscopic examination disclosed a thickening capsule of the liver with a whitish gray hue and congestive branches of the portal vein scattered on the thickened hepatic capsule. The congestive branches of the portal vein stood out in bold relief against the whitish gray hue and they were suggestive of portal hypertension. The subserosal vein of the gallbladder was also congested and the spleen was enlarged. These findings were related to insidious portal hypertension, though no manifestations of portal hypertension could be detected clinically. Moreover, no early history of liver disease or very few abnormal laboratory findings could be found in this case. The histology of the biopsied liver showed markedly proliferated fibrous tissue, especially in the portal areas, as well as somewhat thick septal formation. To date, many laparoscopic findings of portal hypertension were given, but this is the first report of laparoscopically detected findings in which congested branches of the portal vein were scattered and stood out in bold relief against the thickened hepatic capsule.