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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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Abstract

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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References

  • Balthazar, E.J., 2002. Complications of acute pancreatitis: clinical and CT evaluation. Radiol. Clin. North Am., 40(6): 1211–1227. [doi:10.1016/S0033-8389(02)00043-X]

    Article  PubMed  Google Scholar 

  • Bernades, P., Baetz, A., Lévy, P., Belghiti, J., Menu, Y., Fékété, F., 1992. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig. Dis. Sci., 37(3):340–346. [doi:10.1007/BF01307725]

    Article  PubMed  CAS  Google Scholar 

  • Bradley, E.L., 1986. The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery. Int. J. Pancreatol., 2(2):87–92. [doi:10.1007/ BF03015001]

    Google Scholar 

  • Butler, J.R., Eckert, G.J., Zyromski, N.J., Leonardi, M.J., Lillemoe, K.D., Howard, T.J., 2011. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB, 13(12):839–845. [doi:10.1111/j.1477-2574.2011.00375.x]

    Article  PubMed  Google Scholar 

  • Evans, G.R., Yellin, A.E., Weaver, F.A., Stain, S.C., 1990. Sinistral (left-sided) portal hypertension. Am. Surg., 56(12):758–763.

    PubMed  CAS  Google Scholar 

  • Flati, G., Andren-Sandberg, A., La Pinta, M., Porowska, B., Carboni, M., 2003. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas, 26(1):8–14. [doi:10.1097/00006676-2003010 00-00002]

    Article  PubMed  Google Scholar 

  • Gaba, R.C., Katz, J.R., Parvinian, A., Reich, S., Omene, B.O., Yap, F.Y., Owens, C.A., Knuttinen, M.G., Bui, J.T., 2013. Splenic artery embolization: a single center experience on the safety, efficacy, and clinical outcomes. Diagn. Interv. Radiol., 19(1):49–55. [doi:10.4261/1305-3825.DIR.5895-12.1]

    PubMed  Google Scholar 

  • Heider, T.R., Azeem, S., Galanko, J.A., Behrns, K.E., 2004. The natural history of pancreatitis-induced splenic vein thrombosis. Ann. Surg., 239(6):876–880. [doi:10.1097/01.sla.0000128685.74686.1e]

    Article  PubMed  Google Scholar 

  • Ito, K., Kudo, A., Nakamura, N., Tanaka, S., Teramoto, K., Arii, S., 2008. Left-sided portal hypertension caused by serous cystadenoma of the pancreas: report of a case. Surg. Today, 38(2):184–187. [doi:10.1007/s00595-007-3600-y]

    Article  PubMed  Google Scholar 

  • Johnston, F.R., Myers, R.T., 1973. Etiologic factors and consequences of splenic vein obstruction. Ann. Surg., 177(6): 736–739. [doi:10.1097/00000658-197306000-00012]

    Article  PubMed  CAS  Google Scholar 

  • Keith, R.G., Mustard, R.A.Jr., Saibil, E.A., 1982. Gastric variceal bleeding due to occlusion of splenic vein in pancreatic disease. Can. J. Surg., 25(3):301–304.

    PubMed  CAS  Google Scholar 

  • Kim, T., Shijo, H., Kokawa, H., Tokumitsu, H., Kubara, K., Ota, K., Akiyoshi, N., Iida, T., Yokoyama, M., Okumura, M., 1997. Risk factors for hemorrhage from gastric fundal varices. Hepatology, 25(2):307–312. [doi:10.1002/hep.510250209]

    Article  PubMed  CAS  Google Scholar 

  • Koconis, K.G., Singh, H., Soares, G., 2007. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the English language literature. J. Vasc. Interv. Radiol., 18(4):463–481. [doi:10.1016/j.jvir.2006.12.734]

    Article  PubMed  Google Scholar 

  • Little, A.G., Moossa, A.R., 1981. Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis. Am. J. Surg., 141(1): 153–158. [doi:10.1016/0002-9610(81)90029-5]

    Article  CAS  Google Scholar 

  • Madsen, M.S., Petersen, T.H., Sommer, H., 1986. Segmental portal hypertension. Ann. Surg., 204(1):72–77. [doi:10.1097/00000658-198607000-00010]

    Article  PubMed  CAS  Google Scholar 

  • McCormick, P.A., O’Keefe, C., 2001. Improving prognosis following a first variceal haemorrhage over four decades. Gut, 49(5):682–685. [doi:10.1136/gut.49.5.682]

    Article  PubMed  CAS  Google Scholar 

  • Moossa, A.R., Gadd, M.A., 1985. Isolated splenic vein thrombosis. World J. Surg., 9(3):384–390. [doi:10.1007/ BF01655272]

    Article  PubMed  CAS  Google Scholar 

  • Ou, H.Y., Huang, T.L., Chen, T.Y., Tsang, L.L., Concejero, A.M., Chen, C.L., Cheng, Y.F., 2005. Emergency splenic arterial embolization for massive variceal bleeding in liver recipient with left-sided portal hypertension. Liver Transpl., 11(9):1136–1139. [doi:10.1002/lt.20543]

    Article  PubMed  Google Scholar 

  • Petermann, A., Chabrot, P., Cassagnes, L., Dumousset, E., Alfidja, A., Gageanu, C., Ravel, A., Abergel, A., Boyer, L., 2012. Hypersplenism due to portal hypertension: retrospective evaluation of 17 patients treated by splenic embolization. Diagn. Interv. Imaging, 93(1):30–36. [doi:10.1016/j.diii.2011.11.008]

    Article  PubMed  CAS  Google Scholar 

  • Sakorafas, G.H., Sarr, M.G., Farley, D.R., Farnell, M.B., 2000. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am. J. Surg., 179(2):129–133. [doi:10.1016/S0002-9610(00)00250-6]

    Article  PubMed  CAS  Google Scholar 

  • Shah, R., Mahour, G.H., Ford, E.G., Stanley, P., 1990. Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. Am. Surg., 56(12):774–777.

    CAS  Google Scholar 

  • Stabile, B.E., Wilson, S.E., Debas, H.T., 1983. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch. Surg., 118(1):45–51. [doi:10.1001/archsurg.1983.01390010035009]

    Article  PubMed  CAS  Google Scholar 

  • Weber, S.M., Rikkers, L.F., 2003. Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J. Surg., 27(11):1271–1274. [doi:10.1007/s00268-003-7247-6]

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China

    Zhi-yu Li, Bin Li, Yu-lian Wu & Qiu-ping Xie

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  1. Zhi-yu Li
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  2. Bin Li
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  3. Yu-lian Wu
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  4. Qiu-ping Xie
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Correspondence to Qiu-ping Xie.

Additional information

Project supported by the National Natural Science Foundation of China (No. 30901445), the Zhejiang Provincial Natural Science Foundation (No. Y2100285), and the Specialized Research Fund for the Doctoral Program of Higher Education (No. 20090101120122), China

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Li, Zy., Li, B., Wu, Yl. et al. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review. J. Zhejiang Univ. Sci. B 14, 549–554 (2013). https://doi.org/10.1631/jzus.B1200247

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  • DOI: https://doi.org/10.1631/jzus.B1200247

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