Bleeding from isolated gastric varices as complication of a mucinous cystic neoplasm of the pancreas

Abstract

Introduction:Bleeding from isolated gastric varices, though uncommon, may be life threatening and may occur as a consequence of splenic vein thrombosis by tumoral compression and subsequent left-sided portal hypertension.Case overview:We report the case of a 37-year old woman, previously diagnosed with a benign pancreatic cyst, who presented with severe gastric variceal bleeding.Diagnosis, therapeutics interventions, and outcomes:Abdominal ultrasound (US) and computed-tomography (CT) revealed enlargement and changed morphology of the cystic tumor located on the body of the pancreas. Left-sided portal hypertension was disclosed resulting from splenic vein occlusion. Salvage left spleno-pancreatectomy with lymphadenectomy was undertaken with an excellent postoperative outcome. Histological analysis established the diagnosis of mucinous cystic neoplasm with foci of adenocarcinoma.Conclusion:Surgical treatment proved to be the election one, leading to a steady hemostasis, removal of the lesion, positive diagnosis, and resolution of the varices. Imaging follow-up of pancreatic cyst should also assess vascular patency to identify the patient at risk for gastric bleeding and to select patients who benefits from surgical resection.

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

“…Whether asymptomatic patients require treatment remains controversial, but it is necessary to intervene to prevent active bleeding. In addition to addressing bleeding, it is often necessary to treat the primary disease [16,17,19,57,58]. Based on the patient's clinical condition, there are several methods that can be used to relieve isolated gastric bleeding.…”

“…Based on the patient’s clinical condition, there are several methods that can be used to relieve isolated gastric bleeding. To reduce venous blood reflux, splenectomy remains the preferred treatment for patients with gastric bleeding due to LSPH, and splenic artery embolization can be used as a supplementary measure in patients in whom splenectomy is deemed unsuitable [ 13 , 16 , 17 , 19 , 57 – 59 ]. Moreover, while endoscopic therapy is highly advantageous for the treatment of acute massive gastric bleeding, rebleeding is unavoidable [ 60 – 63 ].…”

“…Most patients with LSPH are asymptomatic, and only a few patients exhibit isolated gastric varices, ruptures, and fatal bleeding caused by splenic vein obstruction resulting from thrombosis, mechanical compression, tumor invasion, and metastasis [7][8][9][10][11][12][13][14]. It is difficult to diagnose LSPH [15], and bleeding from LSPH is frequently fatal [8,13,[16][17][18][19]. Diseases resulting in LSPH often need to be distinguished from pancreatic cancer, therefore it is necessary for due attention to be paid to the diagnosis and treatment of LSPH [20][21][22].…”