Splenic varices ct well

The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization.Five of the eight patients had a chronic course with melena, and the other three patients had acute gastric bleeding with melena and hematemesis.In previous clinical studies, it was shown that splenectomy is an effective treatment for symptomatic or asymptomatic SPH.Partial splenic embolization with particle embolic agents has been well accepted for treating hypersplenism and portal hypertension caused by liver cirrhosis [].The causes of SPH were chronic pancreatitis in nine patients, acute pancreatitis in four patients, and pancreatic tumor in another one patients.The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.Although the incidence of SPH has increased gradually in recent decades, there is no consensus on treatment strategy.The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only.Yet, there is controversy regarding whether splenectomy is necessary for the prevention of gastrointestinal bleeding in asymptomatic patients [].Sinistral (left-sided) portal hypertension (SPH) is characterized by obstruction of the splenic vein leading to isolated gastric varices, mainly due to pancreatic diseases such as pancreatitis and pancreatic tumor []. The direct cause of the occlusion is usually thrombosis in the splenic vein or compression by masses or cysts.In this retrospective study, we report our experiences using partial splenic embolization combined with splenic arterial embolization for the treatment of SPH patients with or without gastric bleeding.Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). In 14 patients, splenic arterial embolization was successful.These isolated gastric varices are the characteristic clinical feature of SPH, and may cause life-threatening gastric bleeding [].

From August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization.Gastric bleeding occurred in eight patients who had melena, hematemesis, or both.Blood from the spleen flows towards the stomach via the short gastric veins and then flows towards the portal vein [].Collateral circulation from the short gastric vein leads to the dilation of stomach submucosal vessels and subsequently increased blood flow and venous pressure, resulting in isolated gastric varices.This retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.


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Six asymptomatic patients were diagnosed during the follow-up of chronic pancreatitis.