Abstract
We herein report the case of a 63-year-old woman with a serous cystadenoma of the pancreas presenting with left-sided portal hypertension secondary to isolated splenic vein occlusion. She was admitted to our hospital for sudden hematemesis. Emergency upper gastrointestinal endoscopy revealed hemorrhagic erosive gastritis and isolated varices in the gastric fundus. An abdominal angiographic study disclosed a large hypervascular tumor of the pancreatic tail which caused isolated splenic vein occlusion by tumor compression and formed large hepatopetal collaterals via the gastric varices. The patient underwent tumor resection with splenectomy and, as a result, the gastric varices disappeared and the postoperative course was uneventful. Left-sided portal hypertension secondary to splenic vein occlusion is an uncommon complication mostly associated with pancreatitis and pancreatic carcinoma. Although benign pancreatic neoplasms only rarely cause such a condition, the possibility of gastrointestinal bleeding due to this condition should be carefully taken into consideration when treating pancreatic disease.
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References
Belli L, Puttini M, Marni A (1980) Extrahepatic portal obstruction: Clinical experience and surgical treatment in 105 patients. J Cardiovasc Surg 21:439–448
Moossa AR, Gadd MA (1985) Isolated splenic vein thrombosis. World J Surg 9:384–390
Glynn MJ (1986) Isolated splenic vein thrombosis. Arch Surg 121:723–725
Babb RR (1976) Splenic vein obstruction: A curable cause of variceal bleeding. Dig Dis 21:512–513
Madsen MS, Petersen TH, Sommer H (1986) Segmental portal hypertension. Ann Surg 204:72–77
Sutton JP, Yarborough DY, Richards JT (1970) Isolated splenic vein occlusion. Arch Surg 100:623–626
Little AG, Moossa AR (1981) Gastrointestinal hemorrhage from left-sided portal hypertension. Am J Surg 141:153–158
Lavender S, Leoyd-Davis RW, Thosmas ML (1970) Retro-peritoneal fibrosis causing localized portal hypertension. Br Med J 3:627–628
Angeras U, Almskog B, Lukes P, Lundstam S, Weiss L (1984) Acute gastric hemorrhage secondary to wandering spleen. Dig Dis Sci 29:1159–1163
Grunberg A, Blair JL, Hill CA (1952) Congestive splenomegaly due to pancreatic cystadenoma. Br Med J 2:265–266
Murray JB, Spier J (1961) Cystadenoma of the pancreas. Am J Surg 101:500–504
Pressman BD, Asch T, Casarella WJ (1973) Cystadenoma of the pancreas. Am J Roentgenol 119:115–120
Hodgkinson DJ, ReMine WH, Weiland LH (1978) Pancreatic cystadenoma. A clinicopathologic study of 45 cases. Arch Surg 113:512–519
Talamini MA, Pitt HA, Hruban RH, Boitnott JK, Coleman J, Cameron JL (1992) Spectrum of cystic tumors of the pancreas. Am J Surg 163:117–124
Segesser L, Rohner A (1984) Pancreatic cystadenoma and cystadenocarcinoma. Br J Surg 71:449–451
Van Damme JP, Bonte J (1990) Vascular anatomy in abdominal surgery. Thieme, Stuttgart, p 38
Bok EJ, Cho KJ, Williams DM, Brady TM, Weiss CA, Forrest ME (1984) Venous involvement in islet cell tumors of the pancreas. AJR 142:319–322
Morohoshi T, Held G, Kloppel G (1983) Exocrine pancreatic tumours and their histological classification. A study based on 167 autopsy and 97 surgical cases. Histopathol 7:645–661
Compagno J, Oertel JE (1978) Microcystic adenomas of the pancreas (glycogen-rich cystadenomas). A clinicopathologic study of 34 cases. Am J Clin Pathol 69:289–298
Compagno J, Oertel JE (1978) Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadnocarcinoma and cystadenoma). A clinicopahologic study of 41 cases. Am J Clin Pathol 69:573–580
Pyke CM, Heerden JA, Colby TV, Sarr MG, Weaver AM (1992) The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 215:132–139
Yamasaki N, Oike F, Manabe K, Hasegawa M, Takagi K, Koyama T (1992) A cases of serous cystadenoma of the pancreas, which required concomitant segmental excision of the portal vein and the right hepatic artery. Nihon Shokaki Geka Gakkai Zasshi (Jpn J Gastroenterol Surg) 25:2843–2847
Metz DC, Benjamin SB (1991) Islet cell carcinoma of the pancreas presenting as bleeding from isolated gastric varices. Report of a case and review of the literature. Dig Dis Sci 36:241–244
Ku Y, Kawa Y, Fujiwara S, Nishiyama H, Tanaka Y, Okumura S, Ohyanagi H, Saitoh Y (1989) Hemodynamic study of occlusion of the splenic vein caused by carcinoma of the pancreas. Surg Gynecol Obstet 168:17–24
Itzchak Y, Glickman MG (1977) Splenic vein thrombosis in patients with a normal size spleen. Invest Radiol 12:158–163
Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK (1992) Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. Hepatology 16:1343–1349
Muhletaler CM, Gerlock AJ, Goncharenko V, Avant GR, Flexner JM (1979) Gastric varices secondary to splenic vein occlusion: Radiographic diagnosis and clinical significance. Radiology 132:593–598
Rosenbaum H, Connolly PJ, Climie ARW, Reveno WS (1963) Pancreatic cystadenoma with intestinal hemorrhage. Am J Roentgenol 90:735–739
Johnston FR, Myers RT (1973) Etiologic factors and consequences of splenic vein obstruction. Ann Surg 177:736–739
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Iwasaki, T., Nagata, Y., Watahiki, H. et al. A rare case of serous cystadenoma of the pancreas presenting with left-sided portal hypertension. Surg Today 26, 442–445 (1996). https://doi.org/10.1007/BF00311934
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DOI: https://doi.org/10.1007/BF00311934