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Recurrent variceal haemorrhage managed with splenic vein stenting

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Abstract

Introduction

Extrahepatic Portal Hypertension (EPH) is defined as extrahepatic hypertension of the portal venous system in the absence of liver cirrhosis. Isolated splenic vein stenosis/occlusion as one of the causes of extrahepatic portal hypertension is uncommon, comprising less than 5 % of all cases of portal hypertension. However, it is an increasingly recognised complication of both acute and chronic pancreatitis, and with the advent of more effective diagnostic methods, interventional radiological methods for its management are also becoming more effective. Often these would negate the need for invasive splenectomy surgery for the treatment of symptomatic hypersplenism and varices.

Methods

A case of a 38 year old gentleman, known to have Crohn’s disease, presented with severe acute gallstone pancreatitis with necrosis of the pancreatic neck and body. His course was very complicated, requiring two laparotomies and various interventional drainages of variceal bleeds. As a result of non resolving recurrent variceal haemorrhage, it was decided to proceed with splenic vein stenting to relieve the consequences of splenic vein stenosis. A percutaneous transhepatic splenic vein stent was deployed.

Results

Immediate decompression of the varices was noted with no further haemmorrhage.

Conclusion

There are little data to date on splenic vein stenting in the setting of EPH secondary to non-malignant pancreatic disease. We report a case managed successfully with splenic vein stenting and review the existing literature.

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Acknowledgments

There was no funding from any source in the selection preparation of this case report.

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Authors and Affiliations

  1. Beaumont Hospital, Royal College of Surgeons, Dublin 9, Ireland

    W. El Kininy & L. Kearney

  2. Beaumont Hospital, Dublin 9, Ireland

    N. Hosam

  3. Professor of Surgery, Royal College of Surgeons Ireland, Beaumont Hospital, Dublin 9, Ireland

    P. Broe

  4. Department of Interventional Radiology, Beaumont Hospital, Dublin 9, Ireland

    A. Keeling

  5. 28 Baltrasna House, Spencer Dock, North Wall Quay, Dublin 1, Ireland

    W. El Kininy

Authors
  1. W. El Kininy
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  2. L. Kearney
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  3. N. Hosam
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  4. P. Broe
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  5. A. Keeling
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Correspondence to W. El Kininy.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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El Kininy, W., Kearney, L., Hosam, N. et al. Recurrent variceal haemorrhage managed with splenic vein stenting. Ir J Med Sci 186, 323–327 (2017). https://doi.org/10.1007/s11845-016-1420-z

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  • DOI: https://doi.org/10.1007/s11845-016-1420-z

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