Massive Gastric Variceal Bleeding in a Patient with Chronic Pancreatitis

Abstract

Left-sided portal hypertension (LSPH) is a rare form of portal hypertension that usually occurs
as a result of isolated obstruction and thrombosis of the splenic vein.
We present a case of a 45-year-old male patient with history of repetitive chronic
pancreatitis exacerbations, who was hospitalized because of the severe gastric variceal bleeding
and hemorrhagic shock, developed as a complication of the splenic vein thrombosis and
LSPH.
Splenectomy is the treatment of choice, but in this case, because of the patient`s severe
general condition and significant risk of new surgical procedure (extensive fibrous adhesions
in abdomen), transcatheter embolization of the splenic artery was undertaken as the method of
“nonsurgical splenectomy”.
Upper endoscopy was performed two weeks after embolization and it showed significantly
reduced gastric varices, with no signs of bleeding, what brings us indirectly to a conclusion
that the embolization significantly decreased pressure in the portal circulation.
KEYWORDS: Left-sided portal hypertension (LSPH); Pancreatitis; Gastric varices; Bleeding;
Embolization.
ABBREVIATIONS: LSPH: Left-sided portal hypertension; MSCT: Multi Slice Computer Tomography;
SVT: Splenic Vein Thrombosis.