title: Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization.
abstract: The use of partial splenic embolization to decrease portal pressure and reduce gastric bleeding from portal-hypertensive gastropathy, a complication of liver cirrhosis, is described. A 62-year-old man with hepatic cirrhosis secondary to hepatitis C and documented portal hypertension was admitted with hypersplenism and bleeding esophageal varices. Endoscopic ligation successfully controlled acute bleeding, but blood loss continued over the next 45 days. Bleeding secondary to portal-hypertensive gastropathy was diagnosed endoscopically. The patient's poor surgical status precluded a portosystemic shunt procedure, so partial splenic embolization was performed radiologically by the injection of Gelfoam squares. Splenic volume decreased 50% following partial embolization. Over 3 weeks, the hemoglobin concentration increased from 8.5 g/dL to 9.8 g/dL, and the platelet count increased from 41,000 to 90,000/microL. Repeat endoscopy found no gastric bleeding 18 days post-procedure. Partial splenic embolization is a radiologic procedure which can be performed safely in patients too ill to undergo portosystemic shunt. This report documents its successful use to manage hypersplenism and reduce portal pressure in a cirrhotic patient with portal-hypertensive gastropathy and hypersplenism.
authors.affiliation: First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Takumi
authors.initials: T
authors.lastname: Aramaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kumazaki
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D005773:Gastroscopy; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D006971:Hypersplenism / Q000000981:diagnostic imaging / Q000628:therapy*; D006975:Hypertension, Portal / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D011172:Portography; D013154:Spleen / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome