Gastric mucosal abnormalities resulting from portal hypertension are defined as "congestive gastropathy". A case of congestive gastropathy with unusual features, in a 63 year old man with a history of excessive alcohol intake and cirrhosis, is described. The patient underwent a subtotal gastrectomy because of profuse bleeding from a gastric ulcer, providing a large surgical specimen for examination. Unusual gross and histological findings included prominent arterial intimal hyperplasia, and diffuse duplication and focal fragmentation of the internal lamina elastica. The differential diagnosis of this condition includes primary angiodysplastic gastropathy such as Dieulafoy's disease. The similarity with Dieulafoy-like angiodysplasia emphasises that clear cut criteria to define gastric vascular lesions do not yet exist.
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