Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report.
BACKGROUND
Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk.


METHODS
We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization.


CONCLUSIONS
Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.
Paramythiotis
Daniel
D
First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. papavramidis@hotmail.com.
Papavramidis
Theodossis S
TS
Giavroglou
Konstantinos
K
Potsi
Stamatia
S
Girtovitis
Fotis
F
Michalopoulos
Antonis
A
Papadopoulos
Vassilis N
VN
Prousalidis
John
J