title: Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization.
abstract: Bleeding from gastric varices due to splenic vein obstruction is extremely rare in children, but it can be catastrophic. Reported herein is the case of a teenager with splenic vein thrombosis and chronic decompensated liver disease from autoimmune hepatitis who presented with massive gastric variceal bleeding. Standard medical management did not control the bleeding. Due to decompensated liver disease and continuous active bleeding, emergency partial splenic artery embolization was preferred over splenectomy or a shunt procedure. Bleeding was successfully controlled by partial splenic artery embolization by decreasing the inflow of blood into the portal system. It is concluded that emergency partial splenic artery embolization is a safer alternative life-saving procedure to manage severe gastric variceal bleeding due to splenic vein obstruction in a patient with high surgical risk. To our knowledge, only one other patient with similar management has been reported in the pediatric age group.
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA. drsskumar@gmail.com
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sankararaman
authors.forename: Sujithra
authors.initials: S
authors.lastname: Velayuthan
authors.forename: Romulo
authors.initials: R
authors.lastname: Vea
authors.forename: John
authors.initials: J
authors.lastname: Herbst
mesh_terms: D000293:Adolescent; D000792:Angiography; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D004621:Embolization, Therapeutic; D004630:Emergencies; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007441:Intubation, Gastrointestinal; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D008297:Male; D009130:Muscle, Smooth / Q000276:immunology / Q000473:pathology; D009336:Necrosis; D013154:Spleen / Q000473:pathology; D013157:Splenic Artery; D013159:Splenic Infarction / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
chemical_list: D001323:Autoantibodies