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Updated: May 28, 2025

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case
Abdulrahman Qatomah1,2, Ali Bessissow3, Yen-I Chen1
1Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, QC, Canada.
Introduction:
Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination with antimicrobial therapy prior to endoscopic variceal ligation. In cases of refractory EVB, trans-jugular intrahepatic portosystemic shunt (TIPSS) is recommended; however, it is contraindicated in up to 35% of cases.
Case Presentation:
We report a case of a 61-year-old male newly diagnosed with hepatocellular carcinoma and extensive portal vein thrombosis. The patient developed a refractory EVB failing medical and endoscopic therapies which was successfully treated with transcutaneous left gastric vein embolization (LGVE).
Conclusion:
LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise.
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