Splenic artery embolization for the treatment of pancreatic portal hypertension complicated by gastric variceal haemorrhage.

Abstract

Pancreatic sinistral portal hypertension (PSPH) is caused by splenic venous outflow tract obstruction, and it accounts for 5% of all cases of portal hypertension [1–3]. When the splenic vein is blocked, the splenic collateral circulation opens, including the short gastric veins (SGVs) and left gastroepiploic vein (LGEV) as the 2 main pathways. The SGVs return to the portal vein through the gastric coronary vein and the LGEV flows through the right gastroepiploic vein to the superior mesenteric vein. Continuous high pressure in the SGVs increases pressure in the gastric mucosal veins, which changes venous structure and results in mucosal varices in the gastric fundus [4, 5]. Gastric variceal bleeding (GVB) is a life-threatening complication of PSPH that requires rapid intervention [6]. Traditional splenectomy is considered the preferred treatment for this condition; however, severe inflammation, adhesions