scholarly journals Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Cureus ◽  
2021 ◽  
Author(s):  
Mona Abraham ◽  
Shreyans Doshi ◽  
Mohammad Maysara Asfari ◽  
John Erikson L Yap ◽  
H. Gregory Bowers
Keyword(s):  
Portal Hypertension ◽  
Variceal Hemorrhage ◽  
Sinistral Portal Hypertension ◽  
Gastric Variceal Hemorrhage

scholarly journals Role of Splenic Artery Embolization in Gastric Variceal Hemorrhage due to Sinistral Portal Hypertension

2018 ◽  
Vol 03 (01) ◽  
pp. 027-036
Author(s):  
Bibin Sebastian ◽  
Soumil Singhal ◽  
Rohit Madhurkar ◽  
Arun Alex ◽  
M. Uthappa
Keyword(s):  
Portal Hypertension ◽  
Splenic Artery ◽  
Venous Pressure ◽  
Splenic Vein ◽  
Venous Hypertension ◽  
Variceal Hemorrhage ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Sinistral Portal Hypertension ◽  
Gastric Variceal Hemorrhage

AbstractSinistral or left-sided portal hypertension is a localized form of portal hypertension usually due to isolated obstruction of splenic vein. Most commonly, it is secondary to pancreatitis. Rarely this can present as life-threatening gastric variceal bleeding. In such patients, splenectomy is traditionally considered as the treatment of choice to relieve venous hypertension. Unfortunately, a surgical operation may not be safe in most of the patients because of the unfavorable operative field. Splenic artery embolization (SAE) is an effective method, theoretically akin to splenectomy, blocking the direct arterial inflow to the spleen and thereby reducing the outflow venous pressure. The authors demonstrate a case of a 58-year-old man who presented with severe gastric variceal hemorrhage due to sinistral portal hypertension (SPH) secondary to an episode of pancreatitis, which he had 1 month back. He was successfully managed by SAE and remains symptom-free. The authors bring to the fore the potential curability of gastric variceal hemorrhage secondary to SPH using SAE, which is a safe and effective interventional radiologic procedure.

scholarly journals Testicular Cancer Presenting as Gastric Variceal Hemorrhage

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Carlos Eduardo Salazar-Mejía ◽  
David Hernández-Barajas ◽  
Edio Llerena-Hernández ◽  
José Luis González-Vela ◽  
María Inés Contreras-Salcido ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Testicular Cancer ◽  
Splenic Vein ◽  
Gastric Varix ◽  
Variceal Hemorrhage ◽  
Solid Malignancy ◽  
Extrinsic Compression ◽  
Serum Alpha Fetoprotein ◽  
Gastric Variceal Hemorrhage ◽  
Partial Thrombosis

Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35. The symptomatology caused by this tumor varies according to the site of metastasis. We present the case of a 26-year-old male who arrived to the emergency department with hematemesis. He had no previous medical history. On arrival, we noted enlargement of the left scrotal sac. There was also a mass in the left scrotum which provoked displacement of the penis and right testis. The serum alpha-fetoprotein level was 17,090 ng/mL, lactate dehydrogenase was 1480 U/L, and human chorionic gonadotropin was 287.4 IU/mL. Upper endoscopy revealed a type 1 isolated gastric varix, treated with cyanoacrylate. A CT scan showed extrinsic compression of the portal vein by lymphadenopathy along with splenic vein partial thrombosis, which caused left-sided portal hypertension. Neoadjuvant chemotherapy was started with etoposide and cisplatin, and seven days later the patient underwent left radical orchiectomy. A postoperative biopsy revealed a pure testicular teratoma. Noncirrhotic left portal hypertension with bleeding from an isolated gastric varix secondary to metastasic testicular cancer has not been described before. Clinicians must consider the possibility of malignancy in the differential diagnosis of a young man presenting with unexplained gastrointestinal bleeding.

scholarly journals S3600 A Rare Case of Esophageal Variceal Hemorrhage in a Patient With Sinistral Portal Hypertension

2021 ◽  
Vol 116 (1) ◽  
pp. S1475-S1476
Author(s):  
Luis Gil ◽  
Andrew Dam ◽  
Alok Shrestha ◽  
Humberto J. Rios ◽  
Andrew Shenouda ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Rare Case ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Sinistral Portal Hypertension

scholarly journals Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Lior Menasherian-Yaccobe ◽  
Nathan T. Jaqua ◽  
Patrick Kenny
Keyword(s):  
Portal Hypertension ◽  
Successful Treatment ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Variceal Hemorrhage ◽  
Splenic Vein Thrombosis ◽  
Packed Red Blood Cells ◽  
Vein Thrombosis ◽  
Shunt Procedure ◽  
Gastric Variceal Hemorrhage

A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

Nonfunctioning Pancreatic Endocrine Tumor Presenting with Hemorrhage from Isolated Gastric Varices

2005 ◽  
Vol 71 (12) ◽  
pp. 1027-1030 ◽  
Author(s):  
Tetsuya Yamaguchi ◽  
Hiroshi Takahashi ◽  
Ryuzaburo Kagawa ◽  
Ryoji Takeda ◽  
Shingo Sakata ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Splenic Vein ◽  
Endocrine Tumor ◽  
Gastric Varices ◽  
Pancreatic Endocrine Tumor ◽  
Variceal Hemorrhage ◽  
Vein Occlusion ◽  
Splenic Vein Occlusion ◽  
Isolated Gastric Varices ◽  
Gastric Variceal Hemorrhage

Hemorrhage from gastric varices due to left-sided portal hypertension is an unusual presentation for pancreatic endocrine tumor. A case of pancreatic endocrine tumor presenting with gastric variceal hemorrhage secondary to left-sided portal hypertension associated with splenic vein occlusion is presented. A 53-year-old man with hemorrhage from isolated gastric varices was referred to our hospital. Laboratory studies revealed normal liver function. Surveys to identify the cause of gastric varices by an abdominal CT, MRCP, and abdominal angiography revealed splenic vein occlusion secondarily attributed to the pancreatic tail tumor and splenomegaly. The pancreatic tumor was suspected to be a resectable endocrine tumor. A distal pancreatectomy, splenectomy, partial resection of the gastric fundus, and limited lymph node dissection were performed. By the histological examination, the diagnosis of nonfunctioning pancreatic endocrine tumor with malignant potential was determined. Three years after the surgery, the patient is doing well and reveals no sign of recurrence. In this case, the unusual presentation for pancreatic endocrine tumors such as a gastric variceal hemorrhage had an advantage that led to early presentation prior to the development of metastases with possible curative surgery.

scholarly journals Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

2021 ◽  
Vol 5 (02) ◽  
pp. 079-085
Author(s):  
Harriet Grout-Smith ◽  
Ozbil Dumenci ◽  
N. Paul Tait ◽  
Ali Alsafi
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Splenic Artery ◽  
Splenic Vein ◽  
Treatment Modalities ◽  
Portal System ◽  
Technical Success Rate ◽  
Randomized Controlled Studies ◽  
Sinistral Portal Hypertension

Abstract Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

Sign in / Sign up

Export Citation Format

Share Document