title: Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion.
abstract: Isolated gastric varices (IGV) can occur in patients with left-sided portal hypertension resulting from splenic vein occlusion caused by thrombosis or stenosis. In left-sided portal hypertension, blood flows retrogradely through the short and posterior gastric veins and the gastroepiploic veins, leading to the formation of an IGV. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. Our patient presented with a rare case of IGV bleeding induced by splenic lymphoma-associated splenic vein occlusion. Splenectomy, splenic artery embolization, and stenting of the splenic vein are the current treatment choices. Chemotherapy, however, is an alternative effective treatment for splenic vein occlusion caused by chemotherapy-sensitive tumors. Our patient responded well to chemotherapy with a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone regimen, and the splenic vein occlusion resolved after the lymphoma regressed.
authors.affiliation: Bao-Chung Chen, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
authors.forename: Bao-Chung
authors.initials: BC
authors.lastname: Chen
authors.forename: Hong-Hau
authors.initials: HH
authors.lastname: Wang
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Lin
authors.forename: Yu-Lueng
authors.initials: YL
authors.lastname: Shih
authors.forename: Wei-Kuo
authors.initials: WK
authors.lastname: Chang
authors.forename: Tsai-Yuan
authors.initials: TY
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle; D003251:Constriction, Pathologic; D003520:Cyclophosphamide / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology*; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D013160:Splenic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013162:Splenic Vein / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D003630:Daunorubicin
keywords: Hematemesis; Isolated gastric varices; Lymphoma; Occlusion; Splenic vein