Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

Paramythiotis, Daniel; Papavramidis, Theodossis S; Giavroglou, Konstantinos; Potsi, Stamatia; Girtovitis, Fotis F.I.; Michalopoulos, Antonios; Papadopoulos, V. N.; Prousalidis, J.

doi:10.1186/1752-1947-4-139

Cited by 19 publications

(18 citation statements)

References 11 publications

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“…Left‐sided PHT due to splenic vein obstruction is more commonly seen in adults secondary to pancreatic pathologies (i.e. chronic pancreatitis and pancreatic tumor) and is known as sinistral PHT . In adults, emergency SAE has been successfully used to treat acute severe gastric variceal bleeding due to SVT .…”

Section: Discussionmentioning

confidence: 99%

Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Sankararaman

Velayuthan

Vea

et al. 2013

Pediatrics International

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A 53-year-old male patient with a history of hepatocellular carcinoma developed gastroesophageal varices refractory to endoscopic injection sclerotherapy (EIS). He required EIS six times in 2 years for recurring variceal bleeding. After hepatic resection, he developed massive splenomegaly. Partial splenic embolization (PSE) was performed to reduce the portal pressure. Varices and variceal bleeding were not detected during 13-year follow up, until the patient died of hepatocellular carcinoma. This is a unique case of gastroe-sophageal varices controlled by PSE and improved portal hypertension.

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Section: Discussionmentioning

confidence: 99%

Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Sankararaman

Velayuthan

Vea

et al. 2013

Pediatrics International

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“…Bertina reported that Von Leiden factor (FVL) deficiency has been reported in 2% to 30% of patients with portal vein thrombosis [15]. Moreover, the other articles found that FVL deficiency was also highly associated with splenic vein thrombosis [16,17]. As other causes, advanced left renal cancer and myeloproliferative disease are recognized.…”

Section: Pathophysiology/symptoms Of Left-sided Portal Hypertensionmentioning

confidence: 99%

“…Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.…”

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confidence: 99%

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Kimura¹

2013

Pancreat Disord Ther

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Sato et al., Pancreatic Dis Ther 2013, S3 http://dx.doi.org/10.4172/2165 Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases Takahiro Sato*, Sho Kitagawa, Mutsuumi Kimura, Takumi Ohmura, Yoshiyasu Karino and Jouji Toyota Department of Gastroenterology, Sapporo Kosei General Hospital, Japan occlusion because of the splenic vein, s anatomy. 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].Due to splenic vein occlusion, splenic venous flow must drain into collateral veins (short gastric vein and left gastroepiploic vein). Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.Although splenic vein occlusion is commonly silent clinically, AbstractGastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches.Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body.Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the sp...

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“…Some authors have reported that splenic artery embolization (SAE) is an effective alternative to splenectomy for the treatment of gastric variceal bleeding with left-sided portal hypertension [2, 5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Kim

Park

Hur

et al. 2016

Case Reports in Medicine

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Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

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Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

Cited by 19 publications

References 11 publications

Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

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