The significance of sinistral portal hypertension complicating chronic pancreatitis

Sakorafas, George H.; Sarr, Michael G.; Farley, David R.; Farnell, Michael B.

doi:10.1016/s0002-9610(00)00250-6

Cited by 152 publications

(160 citation statements)

References 21 publications

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“…Splenectomy is clearly indicated in case of symptomatic splenic vein thrombosis (variceal bleeding), whereas a prophylactic role for splenectomy is controversial [246][247][248]. A good compromise should be to perform a concomitant prophylactic splenectomy when a patient with left-sided portal hypertension and evidence of asymptomatic gastric varices (at endoscopy or CT) is operated for other complications of chronic pancreatitis [248].…”

Section: S2mentioning

confidence: 99%

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Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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Section: S2mentioning

confidence: 99%

“…A good compromise should be to perform a concomitant prophylactic splenectomy when a patient with left-sided portal hypertension and evidence of asymptomatic gastric varices (at endoscopy or CT) is operated for other complications of chronic pancreatitis [248].…”

Section: S2mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

View full text Add to dashboard Cite

show abstract

“…Gastrointestinal bleeding at varying severity (anemia, hematemesis, melena, or hematochezia) is the most common manifestation of this syndrome [9-12]. In a study by Sakorafas et al, gastrointestinal bleeding complicated splenic vein thrombosis in 18% of our patients they reported, although splenomegaly was a constant finding in all patients [13]. In our case, the varices of our patient were symptomatic and presented with hematemesis.…”

Section: Discussionmentioning

confidence: 53%

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

et al. 2010

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IntroductionSplenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk.Case presentationWe describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization.ConclusionsInterventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

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“…A recent meta-analysis by Butler et al (2011), which reviewed 38 articles related to pancreatitis-induced SVT, exhibited that the incidence of SVT in acute pancreatitis was much higher than that in chronic pancreatitis (22.6% vs. 12.4%), but the bleeding rate was similar (6.7% vs. 6.9%). This discrepancy of LSPH incidence and hemorrhage rate may be related to the development and prevalence of CT scan and angiography which made the diagnosis of SVT without severe symptoms much easier (Sakorafas et al, 2000). The enhanced CT scan and angiography were also carried out for our patients, which made it possible for us to accurately diagnose the disease and promptly deliver effective treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

J. Zhejiang Univ. Sci. B

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Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

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The significance of sinistral portal hypertension complicating chronic pancreatitis

Cited by 152 publications

References 21 publications

Italian consensus guidelines for chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

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

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

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