Sinistral portal hypertension caused by body and tail tumors of the pancreas in 40 cases

Abstract

Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort (n =12),emaciation (n =5),low-back pain (n =4),splenomegaly (n =2),hematemesis and melena (n =4),hypoglycemic coma (n =1).All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients (35/40,88％) were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation. Key words: Pancreatic neoplasms; Hypertension, portal; Esophgeal and gastric varices