Alessandra Daskalakis, MD, Martin Moehlen, MD, MPH, FACG Maine Medical Center, Portland, ME
Introduction: Splenic vein thrombosis is a well-documented complication of chronic pancreatitis resulting in sinistral portal hypertension. Gastric variceal bleeding is often treated with transjugular intrahepatic portosystemic shunt (TIPS) or balloon-occluded retrograde transvenous obliteration (BRTO). Splenic vein stenting as a management for gastric variceal bleeding from sinistral portal hypertension is uncommonly described.
Case Description/Methods: A 55-year-old man with hemophilia A and sinistral portal hypertension secondary to splenic vein thrombosis from chronic pancreatitis presented with nausea, coffee ground emesis and syncope. Hemoglobin was 4.9. He received three units of red blood cells. Multi-phase computed tomography of the abdomen identified varices along the greater curvature of stomach with a partially recanalized splenic vein. No spontaneous gastrorenal nor splenorenal shunts were identified. He was maintained on intravenous proton pump inhibition, octreotide infusion, ceftriaxone, and recombinant factor for hemophilia. Upper endoscopy revealed ectopic gastric varices on the greater curvature of the fundus and gastric body (Type 1 & Type 2 Isolated Gastric Varices). In the mid gastric body, there was a large gastric varix with an adherent clot and no active bleeding. He ultimately underwent stenting of the splenic vein with interventional radiology, resulting in resolution of collateral flow on post-procedural imaging.
Discussion: Given this patient’s and others’ risk factors for life-threatening bleeding, splenic vein stenting should continue to be studied as an effective means for treating patients with splenic vein stenosis and/or occlusion.
Figure: Figure shows gastric varices visible along the gastric body on multi-phase computed tomography (A). Subsequent endoscopy shows a non-bleeding gastric varix (B) resulting in referral for TIPS procedure. Splenic vein and tortuous gastric varices visualized with contrast pre-stenting (C) with improvement of flow post-stenting (D).
Disclosures:
Alessandra Daskalakis indicated no relevant financial relationships.
