What Is Caput Medusae?

Medically Reviewed by Minesh Khatri, MD on September 12, 2023
3 min read

Caput medusae is the name for a cluster of swollen veins in your abdomen. The swelling usually appears around the belly button, and the veins branch out from a central point. They are typically painless, but they are a symptom of circulatory problems that are often related to liver disease.‌

The term caput medusae is Latin for “head of Medusa.” Medusa was a character in mythology who had snakes for hair. The swollen veins can look like snakes extending from a knot in the middle that loosely resembles a head.

The appearance of swollen veins around your belly button is a symptom of circulatory issues. The root cause of caput medusae is portal hypertension, which is an increase in pressure in the portal vein. That’s the vein that moves blood from your digestive tract to your liver. 

When the portal vein is blocked, the blood volume increases in the surrounding blood vessels, and they turn into varicose veins. They bulge out and become visible under the skin. Varicose veins are also more fragile than typical veins and prone to bleeding. 

In some cases, a blood clot can cause portal vein blockage. More commonly, portal vein hypertension is a symptom of liver damage. Hepatitis, alcohol abuse, or other types of liver damage cause scar tissue to form on the liver. Those scars restrict blood flow into the liver and cause blood to back up in the portal vein. 

The visible caput medusae may not cause any pain or discomfort. Portal hypertension and liver disease have other noticeable symptoms in addition to distended veins. You may also experience: 

Bleeding in the gastrointestinal tract: If the swollen veins rupture and cause internal bleeding, it is called bleeding varices. This is a medical emergency. You may have symptoms including black, tarry stools or blood in the stools. You might vomit blood if it accumulates in your stomach.  

Abdominal swelling. You might experience ascites, which is a build-up of fluid in your abdomen.

Encephalopathy: Poor liver function can cause confusion and memory issues. 

Atypical blood count. You may have reduced levels of platelets in your blood or a low white blood cell count. This can affect your immune functions.

If you have caput medusae, you should speak to a doctor. When you go for an appointment, your doctor will need to determine the cause of the blockage in your portal vein. They will ask about your health, including if you have a history of liver disease. They may also perform:

  • Blood tests
  • Tests to evaluate your mental function
  • Heart function tests
  • Imaging such as an ultrasound or CT scan
  • Endoscopy, a camera used to examine the upper digestive tract

The treatment for caput medusae depends on what other symptoms you have and the underlying causes of them.‌

Lifestyle changes. If you have liver disease, your doctor will suggest changes to your diet and lifestyle to minimize your symptoms. They will probably ask you to stop drinking any alcohol or taking recreational drugs. You may need to go on a low sodium diet. Talk to your doctor before taking any new medications to make sure they won’t harm your liver further.

Treat bleeding. Internal bleeding from a ruptured vein is a medical emergency. If you have symptoms of internal bleeding, seek medical help right away. Your doctor will give you medication to slow the bleeding. You may need a transfusion to replace lost blood. Your doctor will also probably need to perform an endoscopy to locate the source of the bleeding and make sure it is stopping. Doctors can also seal off ruptures in the veins while doing this.

Surgery. If the less invasive measures don’t stop the bleeding or if you have repeated bleeding episodes, you may need surgery to repair the damage and reroute blood vessels. Doctors will place a tube, called a shunt, in your abdomen to divert most of the blood that would normally go to the liver. Instead, it will flow to another part of your circulatory system. This relieves the pressure in the portal vein.

Liver transplant. If your portal hypertension is caused by severe liver damage, you may be a candidate for a liver transplant. Your doctor will tell you if you need to consider this option.

‌If you have caput medusae, talk to your doctor about treatment. If you suspect you have internal bleeding, seek immediate medical help.