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.

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.

Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
John Romano ◽  
Charles V. Welden ◽  
Jordan Orr ◽  
Brendan McGuire ◽  
Mohamed Shoreibah
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Literature Review ◽  
Variceal Bleeding ◽  
Coil Embolization ◽  
Case Series ◽  
Treatment Modalities ◽  
Post Procedure ◽  
Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

scholarly journals Etiology of Portal Hypertension in Children-An Experience in a Tertiary Centre of Bangladesh

2016 ◽  
Vol 39 (1) ◽  
pp. 14-17
Author(s):  
Salahuddin Mahmud ◽  
Syed Shafi Ahmed ◽  
Jahida Gulshan ◽  
Farhana Tasneem
Keyword(s):  
Portal Hypertension ◽  
Venous Pressure ◽  
Tertiary Care ◽  
Splenic Vein ◽  
Portal System ◽  
Biliary Cirrhosis ◽  
Vein Thrombosis ◽  
Hepatic Diseases ◽  
Chronic Hepatitis B Virus ◽  
Hypertension In Children

Background: Portal hypertension is defined by a pathological increase in portal venous pressure. Any condition that interfere with blood flow at any level within the portal system can lead to portal hypertension. For better management, it is important to determine the underlying cause.Objective: To evaluate the etiology of portal hypertension in children admitted in a tertiary care centre of Bangladesh.Materials & Methods: This cross sectional study was done in the Department of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh on 40 consecutive cases of portal hypertension enrolled from April 2014 to March 2015. Results: Age of the children was 2-12 years with mean age of 7.2±4.3 years and male:female ratio was 1.5:1. Out of 40 children, 32 (80%) developed portal hypertension due to pre-hepatic causes and 8 (20%) hepatic causes. In pre-hepatic causes of portal hypertension, out of 32 children, portal vein thrombosis was found in 20 (62.5%) cases, splenic vein thrombosis in 4 (12.5%) & 8 (25%) were idiopathic. On the other hand hepatic causes of portal hypertension, out of 8 children, cryptogenic was found in 4 (50%) cases, wilson’s disease, chronic hepatitis B virus infection, biliary cirrhosis & autoimmune hepatitis each was found in 1 (12.5%) case. In pre-hepatic cases first variceal bleed much earlier than hepatic cases (4.4±3.6 Vs 7.6±4.6 years).Conclusion: Extra-hepatic diseases were the most common etiology of portal hypertension in studied children. Portal venous thrombosis in extra-hepatic cases & cryptogenic liver disease in intra-hepatic cases were the most common causesBangladesh J Child Health 2015; VOL 39 (1) :14-17

Sinistral Portal Hypertension Prediction During Pancreatoduodenectomy With Splenic Vein Resection

2020 ◽  
Author(s):  
Yoshihiro Ono ◽  
Yu Takahashi ◽  
Masayuki Tanaka ◽  
Kiyoshi Matsueda ◽  
Makiko Hiratsuka ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Splenic Vein ◽  
Sinistral Portal Hypertension ◽  
Vein Resection
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