title: Recurrent variceal haemorrhage managed with splenic vein stenting.
abstract: BACKGROUND
  Extrahepatic Portal Hypertension (EPH) is defined as extrahepatic hypertension of the portal venous system in the absence of liver cirrhosis. Isolated splenic vein stenosis/occlusion as one of the causes of extrahepatic portal hypertension is uncommon, comprising less than 5 % of all cases of portal hypertension. However, it is an increasingly recognised complication of both acute and chronic pancreatitis, and with the advent of more effective diagnostic methods, interventional radiological methods for its management are also becoming more effective. Often these would negate the need for invasive splenectomy surgery for the treatment of symptomatic hypersplenism and varices.
  
  
  METHODS
  A case of a 38 year old gentleman, known to have Crohn's disease, presented with severe acute gallstone pancreatitis with necrosis of the pancreatic neck and body. His course was very complicated, requiring two laparotomies and various interventional drainages of variceal bleeds. As a result of non resolving recurrent variceal haemorrhage, it was decided to proceed with splenic vein stenting to relieve the consequences of splenic vein stenosis. A percutaneous transhepatic splenic vein stent was deployed.
  
  
  RESULTS
  Immediate decompression of the varices was noted with no further haemmorrhage.
  
  
  CONCLUSIONS
  There are little data to date on splenic vein stenting in the setting of EPH secondary to non-malignant pancreatic disease. We report a case managed successfully with splenic vein stenting and review the existing literature.
authors.affiliation: Beaumont Hospital, Royal College of Surgeons, Dublin 9, Ireland. elkininw@tcd.ie.|, 28 Baltrasna House, Spencer Dock, North Wall Quay, Dublin 1, Ireland. elkininw@tcd.ie.
authors.forename: W
authors.initials: W
authors.lastname: El Kininy
authors.affiliation: Beaumont Hospital, Royal College of Surgeons, Dublin 9, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Kearney
authors.affiliation: Beaumont Hospital, Dublin 9, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Hosam
authors.affiliation: Professor of Surgery, Royal College of Surgeons Ireland, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Broe
authors.affiliation: Department of Interventional Radiology, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Keeling
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000473:pathology; D004322:Drainage / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008297:Male; D010179:Pancreas / Q000473:pathology; D013162:Splenic Vein; D015607:Stents
keywords: Extra hepatic portal hypertension; Pancreatitis; Splenic vein occlusion; Splenic vein stenosis; Splenic vein stenting