Overview Site of Anastomosis Clinical Sign Portal ↔ Systemic Esophagus Esophageal varices Left gastric ↔ esophageal Umbilicus Caput medusae Paraumbilical ↔ superficial, inferior, and superior epigastric Rectum Anorectal varices (sometimes referred to as internal hemorrhoids though they are different) Superior rectal ↔ middle and inferior rectal Portal hypertension symptoms varices of "gut, butt, and caput (medusae)" esophageal varices caput medusae anorectal varices (sometimes referred to as hemorrhoids) portal-systemic anastomoses inferior esophagus systemic circulation: esophageal branches of azygos vein portal circulation: esophageal branch of left gastric vein clinical symptom: esophageal varices anal canal (rectum) systemic circulation: middle and inferior rectal vein portal circulation: superior rectal vein clinical symptom: anorectal varices (sometimes referred to as hemorrhoids) paraumbilical region systemic circulation: superficial, inferior, and superior epigastric vein portal circulation: paraumbilical veins clinical symptom: caput medusae treatment relieve portal hypertension by shunting blood to systemic circulation by inserting a portocaval shunt between portal and hepatic vein connecting portal vein to IVC