Abstract
Gastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches. Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body. Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the splenic parenchyma, is another effective method of controlling bleeding from gastric varices secondary to splenic vein occlusion. Treatment of gastric varices secondary to splenic vein occlusion is directed to the underlying pancreatic diseases.
Highlights
Gastric variceal hemorrhage is a common complication of portal hypertension and is associated with higher rates of morbidity and mortality than hemorrhage of esophageal varices [1]
We review the diagnostic and therapeutic approaches, for left-sided portal hypertension due to pancreatic diseases
Sakorafas et al found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]
Summary
Gastric variceal hemorrhage is a common complication of portal hypertension and is associated with higher rates of morbidity and mortality than hemorrhage of esophageal varices [1]. Gastric varices secondary to splenic vein occlusion can cause hypersplenism or gastrointestinal hemorrhaging (left-sided portal hypertension) [5,6,7,8]. Splenic vein occlusion results in left-sided portal hypertension (characterized by gastric varices, splenomegaly and normal liver function) [9,10,11] that is secondary to various diseases [12,13,14]. Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17] This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
