Gastric variceal bleeding due to pancreatitis-induced splenic vein thrombosis

Variceal bleeding remains a fatal complication of portal hypertension. Periampullary varices are rare and, due to their location, are difficult to diagnose and treat. Similar to esophagogastric varices, they are the result of high portosystemic pressures secondary to intrahepatic causes such as cirrhosis and extrahepatic causes such as portal or splenic vein thrombosis. We report a case of a periampullary varix resulting in hemobilia during endoscopic retrograde cholangiopancreatography (ERCP).

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P-BN09 Management of isolated splenic vein thrombosis: Risks and benefits of Anticoagulation

British Journal of Surgery ◽

10.1093/bjs/znab430.010 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Amar M Eltweri ◽

Mohammed Basamh ◽

Ying Yang Ting ◽

Mark Harris ◽

Giuseppe Garcea ◽

...

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Ct Scan ◽

Portal Vein Thrombosis ◽

Variceal Bleeding ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis ◽

Anticoagulation Treatment ◽

Therapeutic Anticoagulation

Abstract Background Isolated splenic vein thrombosis (iSVT) is a common complication of pancreatic disease. Whilst patients remain asymptomatic, there is a risk of sinistral portal hypertension and subsequent bleeding from gastric varices if recanalization does not occur. There is a wide variation of iSVT treatment, even within single centres. We report outcomes of iSVT from tertiary referral hepatobiliary and pancreatic (HPB) units including the impact of anticoagulation on recanalization rates and subsequent variceal bleeding risk. Methods A retrospective cohort study including all patients diagnosed with iSVT on CT scan abdomen and pelvis between 2011 and 2019 from two institutions. Patients with both SVT and portal vein thrombosis at diagnosis, and isolated splenic vein thrombosis secondary to malignancy were excluded. The outcomes of anticoagulation, recanalization rates, risk of bleeding, and progression to portal vein thrombosis were examined. Results Ninety-eight patients with iSVT were included; of which thirty-nine patients received anticoagulation (40%). The most common cause of iSVT was acute pancreatitis n = 88 (90%). The recanalization rate in the anticoagulation group was 46% vs 15% in patients receiving no anticoagulation (p = 0.0008, OR = 4.7, 95% CI 1.775 to 11.72). Upper abdominal vascular collaterals (demonstrated on CT scan angiography) were significantly less among patients who received anticoagulation treatment (p = 0.03, OR = 0.4, 95% CI 0.1736 to 0.9288). The overall rate of upper GI variceal related bleeding was 3% (n = 3/98) and it was independent of anticoagulation treatment. Two of the patients received therapeutic anticoagulation. Conclusions The current data support that therapeutic anticoagulation is associated with a statistically significant increase in recanalization rates of the splenic vein; with a subsequent reduction in radiological left-sided portal hypertension. However, all patients had a very low risk of variceal bleeding regardless of anticoagulation. The findings from this retrospective study should merit further investigation in large-scale randomized clinical trials.

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Splenic artery embolization for the treatment of gastric variceal bleeding caused by splenic vein thrombosis in necrotizing pancreatitis: report of a case

HPB ◽

10.1016/j.hpb.2020.11.540 ◽

2021 ◽

Vol 23 ◽

pp. S215

Author(s):

C.K. Cho ◽

Y.H. Lee ◽

H.J. Kim

Keyword(s):

Variceal Bleeding ◽

Splenic Artery ◽

Necrotizing Pancreatitis ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Vein Thrombosis

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The Role of Splenic Artery Embolization for Gastric Variceal Bleeding Associated with Splenic Vein Thrombosis in Necrotizing Pancreatitis: Report of a Case

HPB ◽

10.1016/j.hpb.2019.10.2111 ◽

2019 ◽

Vol 21 ◽

pp. S408

Author(s):

Chol Kyoon Cho ◽

Hee Joon Kim

Keyword(s):

Variceal Bleeding ◽

Splenic Artery ◽

Necrotizing Pancreatitis ◽

Splenic Vein ◽

Splenic Vein Thrombosis ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Vein Thrombosis

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Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Case Reports in Medicine ◽

10.1155/2016/1585926 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Hee Joon Kim ◽

Eun Kyu Park ◽

Young Hoe Hur ◽

Yang Seok Koh ◽

Chol Kyoon Cho

Keyword(s):

Blood Flow ◽

Variceal Bleeding ◽

Splenic Artery ◽

Necrotizing Pancreatitis ◽

Splenic Vein ◽

Common Finding ◽

Splenic Vein Thrombosis ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Vein Thrombosis

Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

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