Partial splenic artery embolization is effective for bleeding gastric varices due to sinistral portal hypertension associated with pancreatic tail cancer

Abstract

A 49-year-old man was treated with FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) for pancreatic tail cancer with multiple liver metastases, and had a partial response. However, bleeding gastric varices due to sinistral portal hypertension associated with pancreatic tail cancer developed. While repeated endoscopic variceal ligation and endoscopic injection sclerotherapy were performed, the gastric variceal bleeding was difficult to manage endoscopically. Therefore, partial splenic artery embolization (PSE) was performed to treat the bleeding gastric varices, with control of the bleeding. Compared with splenectomy, PSE is less invasive and can be performed with short-term interruption of chemotherapy. PSE is considered effective to control gastric variceal bleeding in patients with bleeding due to left portal hypertension.