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Liu M, Wei N, Song Y. Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis. Therap Adv Gastroenterol 2024; 17:17562848241234501. [PMID: 38450104 PMCID: PMC10916482 DOI: 10.1177/17562848241234501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Objectives Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies. Design A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH. Data sources and methods All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark). Results Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06-0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01-0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01-0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20-1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy. Conclusion This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients. Trial registration This study has been registered on the PROSPERO database with the registration number CRD42023483764.
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Affiliation(s)
- Minghui Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Wei
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuhu Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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2
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Mayer P, Venkatasamy A, Baumert TF, Habersetzer F, Pessaux P, Saviano A, Felli E. Left-sided portal hypertension: Update and proposition of management algorithm. J Visc Surg 2024; 161:21-32. [PMID: 38142180 DOI: 10.1016/j.jviscsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
Left-sided or segmental portal hypertension (SPHT) is a rare entity, most often associated with pancreatic disease or antecedent pancreatic surgery. The starting point is splenic vein obstruction secondary to local inflammation or, less often, extrinsic compression. SPHT leads to splenomegaly and development of collateral porto-systemic venous circulation. SPHT should be suspected in patients with pancreatic history who present with episodic upper gastrointestinal bleeding and splenomegaly with normal liver function tests. The most common clinical presentation is major upper gastrointestinal bleeding secondary to rupture of esophageal and/or gastric varices. At the present time, there are no management recommendations for SPHT, particularly when the patient is asymptomatic. In patients with upper gastro-intestinal bleeding, hemostasis can be obtained either by medical or interventional means according to patient status and available resources. For symptomatic patients, splenectomy is the reference treatment. Recently, less invasive, radiologic procedures, such as splenic artery embolization, have been developed as an alternative to surgery. Additionally, sonography-guided endoscopic hemostasis can also be envisioned, leading to the diagnosis and treatment of the lesion by elastic band ligation or by glue injection into the varices during the same procedure. The goal of this article is to describe the pathophysiological mechanisms behind SPHT and its clinical manifestations and treatment, based on a review of the literature. Because of the absence of recommendations for the management of SPHT, we propose a decisional algorithm for the management of SPHT based on the literature.
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Affiliation(s)
- Pierre Mayer
- Hepato-gastroenterology Department, Hepato-digestive Unit, New Civil Hospital, University Hospitals of Strasbourg (HUS), Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.
| | - Aïna Venkatasamy
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamentale et Appliquée à la Cancérologie, 3 avenue Molière, Strasbourg, France
| | - Thomas F Baumert
- Hepato-gastroenterology Department, Hepato-digestive Unit, New Civil Hospital, University Hospitals of Strasbourg (HUS), Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Inserm U1110, Institute of Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Medical School, Strasbourg, France
| | - François Habersetzer
- Hepato-gastroenterology Department, Hepato-digestive Unit, New Civil Hospital, University Hospitals of Strasbourg (HUS), Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Inserm U1110, Institute of Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Medical School, Strasbourg, France
| | - Patrick Pessaux
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Inserm U1110, Institute of Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Medical School, Strasbourg, France; Hepato-biliary surgery unit, Department of Digestive and Endocrine Surgery, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Saviano
- Hepato-gastroenterology Department, Hepato-digestive Unit, New Civil Hospital, University Hospitals of Strasbourg (HUS), Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Inserm U1110, Institute of Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Medical School, Strasbourg, France
| | - Emanuele Felli
- Inserm U1110, Institute of Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Medical School, Strasbourg, France; Department of Digestive Surgery and Liver Transplantation, Trousseau Hospital, Tours, France
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3
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Bathobakae L, Ozgur SS, Aiken A, Mahmoud A, Escobar J, Melki G, Cavanagh Y, Baddoura W. Sinistral Portal Hypertension Due to a Pancreatic Pseudocyst: A Rare Cause of Upper Gastrointestinal Bleeding. J Investig Med High Impact Case Rep 2024; 12:23247096241231644. [PMID: 38347706 PMCID: PMC10865932 DOI: 10.1177/23247096241231644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
Sinistral portal hypertension (SPH), also known as segmental portal hypertension, is a complication of pancreatic disorders and an extremely rare cause of upper gastrointestinal (GI) bleeding. SPH is observed in patients without cirrhosis and arises from splenic vein thrombosis. Unmitigated backflow of blood may cause gastric venous congestion and ultimately GI hemorrhage. Herein, we report a rare case of massive hematemesis due to SPH in a male patient with a history of chronic pancreatitis and pancreatic pseudocyst. Our patient was successfully treated with endoscopic necrosectomy followed by open splenectomy, distal pancreatectomy, and partial gastric resection.
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Affiliation(s)
- Lefika Bathobakae
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Sacide S. Ozgur
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Arielle Aiken
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Anas Mahmoud
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jessica Escobar
- Medical Library Services, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Gabriel Melki
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Yana Cavanagh
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Walid Baddoura
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
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4
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Watanabe Y, Osaki A, Yamazaki S, Yokoyama H, Takaku K, Sato M, Sato D, Yokoyama N, Waguri N, Terai S. Two Cases of Gastric Varices with Left-sided Portal Hypertension Due to Essential Thrombocythemia Treated with Gastric Devascularization or Partial Splenic Embolization. Intern Med 2023; 62:2839-2846. [PMID: 36823082 PMCID: PMC10602822 DOI: 10.2169/internalmedicine.1273-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 02/25/2023] Open
Abstract
Left-sided portal hypertension (LSPH) is a condition of extrahepatic portal hypertension that often results in bleeding from isolated gastric varices (GVs). LSPH is sometimes caused by myeloproliferative diseases, such as essential thrombocythemia (ET). We herein report two cases of GVs with LSPH due to ET that were successfully controlled by gastric devascularization (GDS) or partial splenic embolization (PSE). Since each patient with LSPH due to ET has a different pathology, optimal treatment should be performed depending on the patient's condition, such as platelet counts, hemodynamics, or the prognosis. We believe that these cases will serve as a reference for future cases.
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Affiliation(s)
- Yusuke Watanabe
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
- Division of Preemptive Medicine for Digestive Disease and Healthy Active Life, School of Medicine, Niigata University, Japan
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Shun Yamazaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Hanako Yokoyama
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Kenichi Takaku
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Munehiro Sato
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Daisuke Sato
- Department of Surgery, Niigata City General Hospital, Japan
| | | | - Nobuo Waguri
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
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5
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Mayer P, Felli E, Enescu I, Habersetzer F, Tripon S. Upper gastrointestinal bleeding due to left side portal hypertension after pancreatic surgery. Hepatobiliary Pancreat Dis Int 2023; 22:81-84. [PMID: 35000846 DOI: 10.1016/j.hbpd.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Institut Hospitalo-universitaire (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France.
| | - Emanuele Felli
- Institut Hospitalo-universitaire (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France; Department of Hepato-biliary and Pancreatic surgery, Pôle Hépato-digestif, Nouvel Hôpital Civil, HUS, Strasbourg, France; Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Iulian Enescu
- Department of Interventional Radiology, Pôle d'imagerie, Nouvel Hôpital Civil, HUS, Strasbourg, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Institut Hospitalo-universitaire (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France; Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Simona Tripon
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Institut Hospitalo-universitaire (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France; Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
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6
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Wang YL, Zhang HW, Lin F. Computed tomography combined with gastroscopy for assessment of pancreatic segmental portal hypertension. World J Clin Cases 2022; 10:8568-8577. [PMID: 36157801 PMCID: PMC9453378 DOI: 10.12998/wjcc.v10.i24.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic segmental portal hypertension (PSPH) is the only type of portal hypertension that can be completely cured. However, it can easily cause varicose veins in the esophagus and stomach and hemorrhage in the digestive tract.
AIM To explore the application of computed tomography (CT) to examine the characteristics of PSPH and assess the risk level.
METHODS This was a retrospective analysis of CT images of 22 patients diagnosed with PSPH at our center. Spearman correlation analysis was performed using the range of esophageal and gastric varices (measured by the vertical gastric wall), the ratio of the width of the splenic portal vein to that of the compression site (S/C ratio), the degree of splenomegaly, and the stage determined by gastroscopy. This study examined whether patients experienced gastrointestinal bleeding within 2 wk and combined CT and gastroscopy to explore the connection between bleeding and CT findings.
RESULTS The range of esophageal and gastric varices showed the best correlation in the diagnosis of PSPH (P < 0.001), and the S/C ratio (P = 0.007) was correlated with the degree of splenomegaly (P = 0.021) and PSPH (P < 0.05). This study revealed that male patients were more likely than females to progress to grade 2 or grade 3 as determined by gastroscopy. CT demonstrated excellent performance, with an area under the curve of 0.879.
CONCLUSION CT can be used to effectively analyze the imaging signs of PSPH, and CT combined with gastroscopy can effectively predict the risk level of gastrointestinal bleeding.
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Affiliation(s)
- Yu-Li Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
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7
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Mohamed AZ, Jazayeri-Moghaddas O, Markovitz M, DeClue C, Barakat E, Davis C. Partial splenic embolization treats recurrent left pleural effusions in a patient with portal venous system thrombosis. Radiol Case Rep 2021; 16:1862-1864. [PMID: 34149975 PMCID: PMC8189874 DOI: 10.1016/j.radcr.2021.04.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
A 56-year-old female with thrombocythemia complicated by portal venous system thrombosis presented with recurrent left pleural effusions after failed recanalization via mechanical thrombectomy and stenting at an outside center. With no other cause, splenic vein thrombosis and left-sided portal hypertension was suggested as a possible etiology. Partial splenic embolization was performed with immediate decrease in effusions and resolution by 8 weeks. Portal and splenic venous system thrombosis may cause recurrent pleural effusions from left-sided portal hypertension and fluid leakage across diaphragmatic defects. Upper pole partial splenic embolization may treat recurrent left pleural effusions and offer an alternative to splenectomy.
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Affiliation(s)
- Ahmed-Zayn Mohamed
- University of South Florida, Morsani College of Medicine, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
- Corresponding author.
| | - Omeed Jazayeri-Moghaddas
- University of South Florida, Department of Radiology, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
| | - Michael Markovitz
- University of South Florida, Department of Radiology, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
| | - Christopher DeClue
- University of South Florida, Department of Radiology, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
| | - Elie Barakat
- University of South Florida, Department of Radiology, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
| | - Clifford Davis
- University of South Florida, Department of Radiology, 12901 Bruce B. Downs Blvd. MDC 41, Tampa, Florida, 33612
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8
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Extramedullary Plasmacytoma of the Pancreas Complicated with Left-Sided Portal Hypertension-a Case Report and Literature Review. J Gastrointest Cancer 2020; 50:962-966. [PMID: 30033507 DOI: 10.1007/s12029-018-0146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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9
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Di Martino M, de la Hoz Rodríguez A, Real Martínez Y, Martín-Pérez E. Left-sided portal hypertension due to retroperitoneal fibrosis treated with an oesophagus preserving, modified Sugiura procedure. Ann R Coll Surg Engl 2020; 102:e48-e50. [PMID: 31660755 PMCID: PMC6996417 DOI: 10.1308/rcsann.2019.0138] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2019] [Indexed: 02/02/2023] Open
Abstract
Left-sided portal hypertension is a very uncommon condition and retroperitoneal fibrosis has rarely been reported as a cause. We present the case of a 77-year-old man with retroperitoneal fibrosis obstructing the splenic vein and causing recurrent episodes of upper gastrointestinal bleeding. Computed tomography showed a retroperitoneal mass as being responsible for the obstruction of the splenic vein, splenomegaly, and diffuse varices around the gastrosplenic and gastrohepatic ligaments. An oesophagus preserving, modified Sugiura procedure was performed with disconnection of the gastric vessels on the lesser curve of the stomach, preserving the pylorus branches of the nerves of Latarjet.
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10
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Pandey V, Patil M, Patel R, Chaubal A, Ingle M, Shukla A. Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India. J Family Med Prim Care 2019; 8:818-822. [PMID: 31041207 PMCID: PMC6482754 DOI: 10.4103/jfmpc.jfmpc_414_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Splenic vein thrombosis (SVT) is most commonly caused by acute and chronic pancreatitis (CP). Variceal gastrointestinal (GI) bleeding is a potentially life-threatening event in such patients. The aim of this study was to determine the prevalence of SVT in CP patients and the risk of variceal GI bleeding. Materials and Methods: A total of 187 consecutive patients with a diagnosis of CP were assessed for the presence of SVT at the gastroenterology department of a tertiary care hospital. Thirty seven patients had evidence of SVT. Patients with portal vein thrombosis or cirrhosis were excluded. Potential factors associated with SVT were assessed. Results: Of the 187 CP patients assessed, 37 patients (19.8%) (male 33; female 4; mean age 41.9 years) had evidence of SVT. Among patients with SVT, most common etiology of CP was alcohol abuse (70.3%). Seven patients (18.9%) with SVT presented with clinically significant upper GI bleeding. The source of GI bleeding was gastric varices in three patients (8.1%) and non-variceal source in four patients (10.8%). All three patients with gastric varices were managed by splenectomy. There were no new variceal bleeding episodes in other 33 patients (89.2%) during mean follow-up of 16.4 months. On comparison of patients with and without SVT, the factors associated with significantly higher incidence of SVT were smoking (P = 0.019, odds ratio 3.021, 95% confidence interval 1.195–7.633) and presence of pseudocyst (P = 0.008, odds ratio 3.743, 95% confidence interval 1.403–9.983). Complete resolution of SVT was seen in three patients (8.1%) after resolution of underlying pseudocyst. Conclusion: SVT is a common complication of CP, particularly in patients with pseudocysts and history of smoking. Most patients remain asymptomatic and the risk of variceal bleeding is low. Splenectomy is the treatment of choice in patients with variceal bleeding. Conservative approach is preferred in other patients. Resolution of pseudocysts may lead to resolution of SVT in some patients.
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Affiliation(s)
- Vikas Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Mallangoud Patil
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Ruchir Patel
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Alisha Chaubal
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
| | - Akash Shukla
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
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11
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Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. ACTA ACUST UNITED AC 2018; 31:291-302. [PMID: 28438854 DOI: 10.21873/invivo.11058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Since its introduction in the early 1990s, laparoscopic splenectomy (LS) has gained worldwide acceptance for spleen removal, especially in hematological patients. AIM The present review summarizes the current knowledge and results of LS for the treatment of benign hematological diseases in adults. MATERIALS AND METHODS A MEDLINE/PubMed database research was performed using the terms: "laparoscopic splenectomy" OR "laparoscopy" OR "splenectomy" AND "hematological disorders" OR "hematological disease" OR "hematology" AND "adults" as key words. We set our analysis starting date as January 1st 2010 and the end date as December 31st 2016. We identified 247 relative articles. All the references from the identified articles were searched for relevant information. RESULTS Twenty-seven articles were deemed appropriate for our analysis. LS was found to be feasible and safe in the majority of patients with benign hematological disorders, with a mortality rate ranging from 0% to less than 4% and the postoperative complications rate from 0% to 35.7%. The conversion rate was also very low (4%) and response (complete or partial) was achieved in more than 80% of patients. Lateral approach with four trocars was the most commonly used approach with concommitant cholecystectomy being correlated with increased operative time and morbidity. CONCLUSION Current literature holds that whenever splenectomy is required for the treatment of hematological disorders in adults, a laparoscopic approach should be offered as the gold standard. However, to strengthen the clinical evidence in favor of LS, more high-quality clinical trials on several issues of the procedure are necessary.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.A.
| | - Nikoletta Dimitriou
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
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12
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Pak S, Valencia D, Kim J, Dee C. Melena as Initial Presentation of Adenocarcinoma in Pancreatic Tail. Cureus 2017; 9:e1744. [PMID: 29218259 PMCID: PMC5714399 DOI: 10.7759/cureus.1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Melena associated with gastric varices, in the setting of possible obstructing pancreatic adenocarcinoma, has been poorly documented as an initial presenting sign for pancreatic malignancy. Considering the late presentation of patients with pancreatic malignancy, it is important to consider all potential presenting symptoms for the early detection and treatment of pancreatic malignancy. Below, we present a patient with no history of liver pathology, who presents with melena and gastric varices, likely relating to portal hypertension in the setting of an obstructing pancreatic malignancy.
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Affiliation(s)
- Stella Pak
- Internal Medicine, Kettering Medical Center
| | | | - James Kim
- Department of Medicine, Kettering Medical Center
| | - Christine Dee
- Wright State University Boonshoft School of Medicine
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13
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Gyoten K, Mizuno S, Nagata M, Ogura T, Usui M, Isaji S. Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection. World J Surg 2017; 41:2111-2120. [PMID: 28258459 PMCID: PMC5504262 DOI: 10.1007/s00268-017-3916-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH). METHODS The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence. RESULTS The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05). CONCLUSION In PD with resection of PV-SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.
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Affiliation(s)
- Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Motonori Nagata
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Toru Ogura
- Clinical Research Support Center, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masanobu Usui
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Abstract
Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.
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15
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Left-Sided Portal Hypertension: A Sinister Entity. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:234-239. [PMID: 28868415 PMCID: PMC5579986 DOI: 10.1016/j.jpge.2015.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/11/2015] [Indexed: 12/14/2022]
Abstract
Introduction Sinistral, or left-sided, portal hypertension (SPH) is a rare entity, with multiple potential causes. Gastrointestinal variceal bleeding and hypersplenism are its’ major clinical manifestations. The main aim of the present study is to summarize the clinical features of patients with SPH. Patients and methods This was a retrospective analysis of consecutive patients with present or previous diagnosis of SHP, observed in a Gastroenterology Department, in a period of 2 years. Patients with clinical, radiological or laboratory alterations suggestive of cirrhosis were excluded. Causes of SPH, clinical manifestations and outcomes were registered. Potential factors associated with gastrointestinal bleeding were analyzed. Results In the study period a total of 22 patients (male – 17; mean age – 59.6 ± 10.6 years) with SHP were included. Clinical manifestations were: asymptomatic/unspecific abdominal pain (n = 14); gastrointestinal bleeding (n = 8). Eleven (50%) patients had increased aminotransferases, GGT and/or alkaline phosphatase although liver function was normal in all of them. Causes of SPH were chronic pancreatitis (n = 7), acute pancreatitis (n = 7), pancreatic cancer (n = 4), pancreatic surgery (n = 3) and arteriovenous malformation (n = 1). All patients had gastric and/or esophageal varices and seven had splenomegaly. Five (22.7%) had thrombocytopenia, associated with hypersplenism. Five patients (22.7%) were submitted to endoscopic treatment and eight were submitted to splenic artery embolization and/or splenectomy. There were no cases of variceal rebleeding and two patients died. Patients without liver enzymes elevation had a higher probability of gastrointestinal bleeding (87.5% vs. 28.6%; p = 0.024). Conclusions Acute and chronic pancreatitis are the major causes of SHP. Gastrointestinal bleeding is the most important clinical manifestation and patients without liver enzyme elevation seem more prone to bleed. Specific treatment is seldom performed or needed.
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16
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Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part II: Diagnosis, complications, and management. Dis Mon 2015; 61:5-37. [PMID: 25681098 DOI: 10.1016/j.disamonth.2014.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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