Sinistral Portal Hypertension: Clinical Features and Surgical Treatment of Chronic Splenic Vein Occlusion

Objective: Sinistral, or left-sided, portal hypertension (SPH) is a rare cause of upper gastrointestinal hemorrhage. This retrospective analysis summarizes the clinical features of SPH and the results of surgical treatment. Subjects and Methods: Between 2000 and 2009, patients from our hospital diagnosed with SPH were identified. Diagnosis of SPH was based on evidence of isolated splenic vein thrombosis, splenomegaly, gastroesophageal varices and exclusion of other causes of portal hypertension. Results: Eight males and 5 females were included in the study, with a mean age of 43.5 8 6.4 years (range: 31–68 years). Liver function was normal in all patients. Causes of SPH were chronic pancreatitis (n = 7), pancreatic cancer (n = 3), pancreatic cysts (n = 2) and neuroendocrine tumor (n = 1). The main clinical manifestations were gastrointestinal hemorrhage in 7 cases (53.8%), upper abdominal pain in 10 (76.9%) and hypersplenism in 12 (92.3%). All patients had splenomegaly and gastroesophageal varices. Twelve patients underwent splenectomy and 1 Received: November 2, 2010 Accepted: April 14, 2011 Published online: October 19, 2011 Prof. Le-Xin Wang School of Biomedical Sciences Charles Sturt University Wagga Wagga, NSW 2678 (Australia) Tel. +61 2 6933 2905, E-Mail lwang @ csu.edu.au © 2011 S. Karger AG, Basel 1011–7571/12/0211–0020$38.00/0 Accessible online at: www.karger.com/mpp Sinistral Portal Hypertension Med Princ Pract 2012;21:20–23 21 The treatment of choice for symptomatic patients suffering recurrent variceal bleeding [6] is splenectomy; however, surgical treatment of asymptomatic patients remains controversial [5] . In this report, we describe the clinical features and outcomes of 13 patients following surgical treatment of SPH. Subjects and Methods Records of all patients with SPH diagnosed at Liaocheng People’s Hospital between January 2000 and December 2009 were reviewed retrospectively. Diagnosis of SPH was based on evidence of isolated splenic vein thrombosis, splenomegaly and gastroesophageal varices determined by digital subtraction angiography. Splenomegaly and splenic vein thrombosis or occlusion were mainly diagnosed by Doppler ultrasonography, CT or MRI before surgical treatment [6] . Diagnostic criteria for SPH were (1) presence of pancreatic pathology, (2) clinical or laboratory evidence of portal hypertension, including total or partial occlusion of the splenic vein and splenomegaly, and (3) exclusion of other causes of portal hypertension, such as concomitant portal vein thrombosis or liver cirrhosis. Patient demographics, symptoms and signs, associated conditions, laboratory data, diagnostic evaluation, survival and new or recurrent gastrointestinal bleeding were retrieved from medical records. Follow-up was based on the last clinical evaluation in the patient’s history. The study was approved by the institutional review board of Liaocheng People’s Hospital. No statistical analysis was conducted since this is largely a descriptive study.