title: Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization.
abstract: BACKGROUND
  Left-sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy (LS). Although some studies have reported the feasibility of the laparoscopic approach in the setting of cirrhosis-related portal hypertension, experience concerning LS in left-sided portal hypertension is lacking.
  
  
  METHODS
  A 39-year-old man was admitted to the Emergency Department for haemorrhagic shock due to acute hemorrhage from gastric fundus varices. Diagnostic work up revealed a chronic pancreatitis-related splenic vein thrombosis causing left-sided portal hypertension with gastric fundus varices and splenic cavernoma. Following splenic artery embolization (SAE), the case was successfully managed by LS.
  
  
  CONCLUSIONS
  The advantages of laparoscopic over open splenectomy include lower complication rate, quicker recovery and shorter hospital stay. Splenic artery embolization prior to LS has been used to reduce intraoperative blood losses and conversion rate, especially in complex cases of splenomegaly or cirrhosis-related portal hypertension. We report a case of complicated left-sided portal hypertension managed by LS following SAE. In spite of the presence of large varices at the splenic hilum, the operation was performed by laparoscopy without any major intraoperative complication, thanks to the reduced venous pressure achieved by SAE.
  
  
  CONCLUSIONS
  Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy.
authors.affiliation: General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Patrono
authors.affiliation: General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Benvenga
authors.affiliation: General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Moro
authors.affiliation: Radiology Department, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
authors.forename: Denis
authors.initials: D
authors.lastname: Rossato
authors.affiliation: General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: General Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy. Electronic address: mauro.salizzoni@unito.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
keywords: Laparoscopic splenectomy; Left-sided portal hypertension; Portal hypertension; Splenic artery embolization; Splenic cavernoma