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Related Experiment Videos

Sinistral (left-sided) portal hypertension.

G R Evans1, A E Yellin, F A Weaver

  • 1Department of Surgery, University of Southern California, Los Angeles 90033.

The American Surgeon
|December 1, 1990
PubMed
Summary

Splenic vein thrombosis (SVT) can cause sinistral portal hypertension (SPH) and gastric varices. Splenectomy is an effective treatment for SPH, preventing further bleeding in most patients.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Abdominal Radiology

Background:

  • Splenic vein thrombosis (SVT) is a condition that can lead to sinistral portal hypertension (SPH).
  • SPH is characterized by gastric varices and normal hepatic function, often caused by pancreatic pathology.
  • Diagnosis and treatment of SVT and SPH are crucial for managing bleeding complications.

Purpose of the Study:

  • To review the institution's experience with splenic vein thrombosis (SVT) and sinistral portal hypertension (SPH) between 1953 and 1988.
  • To evaluate the diagnostic methods and treatment outcomes for patients with SVT and SPH.
  • To establish splenectomy as the preferred treatment for SPH.

Main Methods:

  • Retrospective review of 21 patients with SVT, 12 diagnosed with SPH.
  • Diagnostic modalities included autopsy, splanchnic angiography, splenoportography, CT, ultrasonography, endoscopy, and barium swallow.
  • Treatment options evaluated were splenectomy, en bloc distal pancreatectomy, and splenic artery embolization.

Main Results:

  • SVT was identified in 21 patients; 12 presented with SPH due to pancreatic neoplasm, chronic pancreatitis, or pseudocyst.
  • Splenectomy was performed in 10 patients, with no further bleeding in 10 out of 11 treated patients over follow-up periods ranging from 1 week to 14 years.
  • Splenic artery embolization was used in two high-risk patients, one as a prelude to splenectomy and one as definitive therapy.

Conclusions:

  • Sinistral portal hypertension is a clinical syndrome resulting from splenic vein thrombosis, primarily caused by pancreatic pathology.
  • Splanchnic arteriography is essential for accurate diagnosis of SVT and SPH.
  • Splenectomy is the effective treatment of choice for sinistral portal hypertension, significantly reducing bleeding risk.

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