Case Report Extra Hepatic Portal Vein Obstruction leading to variceal bleed due to Portal Hypertension Shafiq Ur Rehman, Muhammad Farhan Amin* Surgical Unit IV, Medical Unit IV*, Civil Hospital, Karachi. Abstract Portal Hypertension can be due to many causes other than cirrhosis. We report a case of extra hepatic por- tal vein obstruction leading to portal hypertension and varices, managed successfully by creating a Porto Caval shunt. Introduction Portal hypertension is defined by a hepatic venous pressure gradient (HVPG) >5mmHg. It may be due to increased resistance to flow because of extra hepatic por- tal vein obstruction, a pre-hepatic cause or others like (hepatic and post-hepatic) and increased portal blood flow. Portal hypertension results in the development of collater- als to bypass the increased resistance to flow within the portal bed and to return blood to the systemic circulation. Esophageal varices, the most important collaterals, form and bleed only if HVPG >12 mmHg. 1 Gastrointestinal bleeding is the most severe complica- tion of portal hypertension and esophageal and gastric varices are by far the most common sources of bleeding in these patients. After an initial variceal hemorrhage,