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Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization
Tetsuya Shimizu1, Masahiko Onda, Takashi Tajiri
1First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Hepato-Gastroenterology
|July 30, 2002
Summary
Partial splenic embolization effectively reduced portal pressure and gastric bleeding in a cirrhotic patient. This minimally invasive procedure offers a safe alternative for managing portal hypertension complications when surgery is not feasible.
Area of Science:
- Interventional Radiology
- Hepatology
- Gastroenterology
Background:
- Portal hypertension is a serious complication of liver cirrhosis, leading to conditions like hypersplenism and gastric bleeding.
- Portal-hypertensive gastropathy presents a significant challenge in managing bleeding in cirrhotic patients.
- Surgical interventions like portosystemic shunts may not be suitable for all patients due to poor surgical status.
Observation:
- A 62-year-old male with hepatitis C-induced cirrhosis and portal hypertension presented with hypersplenism and bleeding esophageal varices.
- Despite endoscopic ligation, continuous bleeding from portal-hypertensive gastropathy persisted.
- The patient's poor surgical condition precluded shunt surgery.
Findings:
- Partial splenic embolization (PSE) was performed radiologically, achieving a 50% reduction in splenic volume.
- Following PSE, hemoglobin levels increased from 8.5 to 9.8 g/dL, and platelet counts rose from 41,000 to 90,000/microL.
- Endoscopic evaluation 18 days post-procedure confirmed the cessation of gastric bleeding.
Implications:
- Partial splenic embolization is a safe and effective radiologic intervention for managing hypersplenism and portal hypertension-related bleeding in cirrhotic patients.
- PSE serves as a viable alternative for patients ineligible for surgical shunt procedures.
- This technique demonstrates potential in improving hematological parameters and controlling gastrointestinal hemorrhage in complex liver disease cases.