Regional portal hypertension

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Thrombosis of the splenic vein may result in massive upper gastrointestinal bleeding. In this situation, the venous return from the spleen, body and tail of the pancreas, and short gastric vessels is blocked, creating a high pressure system in the left side of the portal venous system with formation of collaterals and gastroesophageal varices. Those located in the submucosal plexus of the stomach and the lower esophagus are exposed to rupture and bleeding when the mucosal barrier is violated. Although this is an uncommon entity, isolated thrombosis of the splenic vein is found in chronic pancreatitis,1 pancreatic pseudocyst,2, 3 pancreatic carcinoma,1, 4, 5 and less frequently in islet cell adenoma, retroperitoneal fibrosis, and cavernous transformation of the splenic vein.

The diagnosis, treatment, and prognosis of splenic thrombosis differ from other types of portal hypertension. This condition is probably more common than has been suspected, although the exact incidence is unknown.

Case 1

A 39-year-old woman was in good health until 2 months before hospital admission. During this time she twice noted melena and anemia. The hemoglobin levels were 4.6 g/dl and 5.6 g/dl. She was hospitalized and transfusions were given. An upper gastrointestinal roentgenogram and barium enema were normal. She had consumed an excessive amount of alcohol for 20 years. Physical examination disclosed moderate splenomegaly. Endoscopic examination of the upper gastrointestinal tract revealed a few scattered superficial erosions of the body of the stomach and antrum without active bleeding. No varices were seen in the esophagus and stomach. The percutaneous . . .



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