In the differential diagnosis of the aetiology of portal hypertension arterio-portal fistulas as a rare cause have to be taken in account. The case of a 70-year-old male presenting with massive upper gastrointestinal bleeding secondary to gastric varices caused by a vascular malformation of the gastric fundus is reported and the problem of non-cirrhotic portal hypertension is discussed. In case of variceal bleeding aetiology of portal hypertension has to be clarified exactly before any kind of therapeutic intervention to avoid therapeutic pitfall.
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