Isolated splenic vein thrombosis

Abstract

Isolated splenic vein thrombosis is being recognized more frequently as a complication of pancreatic disease and as the cause of gastrointestinal hemorrhage in patients without liver disease. The increased incidence reflects advances in diagnostic radiology and a higher index of suspicion for the diagnosis. Splenic vein thrombosis should be suspected in: (a) a patient with a history of pancreatitis and gastrointestinal blood loss; (b) a patient with splenomegaly in the absence of portal hypertension, cirrhosis, or hematologic disease; and (c) in the setting of isolated gastric varices. Celiac angiography has replaced splenoportography as the definitive diagnostic tool for splenic vein thrombosis and is indicated prior to operation for suspected portal hypertension or for complications of pancreatitis. The importance of making the diagnosis lies in differentiating the lesion from the more common case of hepatic and extrahepatic portal hypertension. The treatment of choice is splenectomy.

Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

“…LSPH, also known as sinistral or linear portal hypertension, is a rare clinical syndrome characterized by splenomegaly, isolated vein varices, and normal liver condition (Moossa and Gadd, 1985;Madsen et al, 1986;Ito et al, 2008). In most cases, the varices are formed in the fundus of the stomach, while sometimes the esophageal is involved (Weber and Rikkers, 2003), which could lead to severe GI bleeding.…”

“…Most commonly, LSPH is asymptomatic and is diagnosed occasionally by examinations for other diseases (Bradley, 1986). While in symptomatic cases, GI bleeding is the most common symptom occurring in about 45%-72% of patients with LSPH (Moossa and Gadd, 1985;Madsen et al, 1986). Acute pancreatitis associated upper GI bleeding is the most rapidly fatal complication of acute pancreatitis, with a reported fatal frequency of 1.2%-14.5% (Stabile et al, 1983;Flati et al, 2003).…”

“…Left-sided portal hypertention (LSPH) is a rare cause of GI bleeding, which is characterized as splenomegaly, isolated gastric varices, and normal liver condition (Moossa and Gadd, 1985;Madsen et al, 1986;Ito et al, 2008). Sixty percent of cases are followed by pancreatitis, specifically chronic pancreatitis, accompanied by splenic venous thrombosis (SVT) (Madsen et al, 1986), and may progress into severe GI bleeding.…”

A Case of Solid Pseudopapillary Neoplasm of the Pancreas Presenting with Left-sided Extrahepatic Portal Hypertension

“…Gastric varices also occur sometimes in patients with pancreatic disease. In particular, stenosis or occlusion of the splenic vein, caused by the spread of inflammation from chronic pancreatitis or the invasion of pancreatic cancer, sometimes triggers left-sided extrahepatic portal hypertension, associated with characteristic gastric varices extending from the fornix to the greater curvature of the gastric body (1)(2)(3)(4)(5)(6). With respect to the hemodynamics, splenic vein occlusion leads to the development of a collateral pathway through which blood flows retrogradely in the short gastric veins, via the vessels of the gastric wall, and hepatopetally into the portal vein from the left gastric vein.…”

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

“…Sutton et al reported that 35% of their cases of isolated splenic vein occlusion were caused by tumors and only 17% by pancreatitis [9]. On the other hand, Sakorafas et al found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]. There is a possible pathogenetic mechanism implying the increased intra-abdominal pressure leading to compression of the splenic vein in the case of pancreatic pseudocyst [19,20].…”