A Case report of gasrtric varices with left-sided portal hypertension

Abstract

A 75-year-old man has been conservatively treated for insulinoma since for 5 years ago, and followed-up as the left-sided portal hypertension. He was admitted to our hospital because of anemia. Gastrointestinal endoscopy revealed isolated varices in the fundus of stomach and oozing bleeding from gastric corpus varices. Abdominal CT scan showed the splenic vein completely obstructed by a huge malignant lesion of the pancreas tail. Angiography showed the splenic vein interrupted at the hilum of the spleen, and bloodstream flowed from the short gastric vein to the pericardiophrenic vein, and the most of bloodstream flowed to trunk of the splenic vein intermediated posterior gastric vein. Surgically splenectomy and devascularization were applied. After surgery, varices of the gastric body were disappeared and there was never bleeding thereafter. However, blood flow from the short gastric vein leaked out to the portal system and the pericardiophrenic vein and isolated varices remained.
Left-sided portal hypertension with complicated pancreatic neoplasms is comparatively rare. Splenectomy and devascularization were so effective for the control of bleeding from gastric varices.