title: Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass.
abstract: BACKGROUND
  Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage.
  
  
  METHODS
  In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient.
  
  
  CONCLUSIONS
  Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.
authors.affiliation: Department of Surgery, University Hospital of the RWTH Aachen, Germany. kvontrotha@ukaachen.de
authors.forename: Klaus T
authors.initials: KT
authors.lastname: von Trotha
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.forename: Son
authors.initials: S
authors.lastname: Truong
authors.forename: Florian F
authors.initials: FF
authors.lastname: Behrendt
authors.forename: Hermann E
authors.initials: HE
authors.lastname: Wasmuth
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Marc
authors.initials: M
authors.lastname: Jansen
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005773:Gastroscopy; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D013157:Splenic Artery / Q000601:surgery*; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018616:Ultrasonography, Doppler, Duplex