Case Report
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World J Gastroenterol. Oct 28, 2013; 19(40): 6939-6942
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6939
Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion
Bao-Chung Chen, Hong-Hau Wang, Yu-Chieh Lin, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh
Bao-Chung Chen, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Hong-Hau Wang, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Yu-Chieh Lin, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Chen BC designed the report; Hsieh TY was the attending physician for the patient; Shih YL performed the ultrasound-guided aspiration biopsy; Lin YC performed the pathological examinations; Wang HH performed the imaging diagnosis; Chang WK assisted with editing and proof-reading; Hsieh TY organized the report; and Chen BC wrote the paper.
Correspondence to: Tsai-Yuan Hsieh, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei 114, Taiwan. tyh8121@gmail.com
Telephone: +886-2-87923311 Fax: +886-2-87927139
Received: May 27, 2013
Revised: August 12, 2013
Accepted: August 16, 2013
Published online: October 28, 2013
Abstract

Isolated gastric varices (IGV) can occur in patients with left-sided portal hypertension resulting from splenic vein occlusion caused by thrombosis or stenosis. In left-sided portal hypertension, blood flows retrogradely through the short and posterior gastric veins and the gastroepiploic veins, leading to the formation of an IGV. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. Our patient presented with a rare case of IGV bleeding induced by splenic lymphoma-associated splenic vein occlusion. Splenectomy, splenic artery embolization, and stenting of the splenic vein are the current treatment choices. Chemotherapy, however, is an alternative effective treatment for splenic vein occlusion caused by chemotherapy-sensitive tumors. Our patient responded well to chemotherapy with a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone regimen, and the splenic vein occlusion resolved after the lymphoma regressed.

Keywords: Isolated gastric varices, Splenic vein, Lymphoma, Occlusion, Hematemesis

Core tip: Isolated gastric varices occur in patients with splenic vein occlusion caused by thrombosis, stenosis, or cancer, such as pancreatic, colon, gastric, or renal cancers. Here, we describe a rare case of an isolated gastric varices in an elderly woman who presented with tarry stool and bloody vomitus. The diagnostic tests revealed a splenic B-cell lymphoma, which caused splenic vein occlusion that resulted in isolated gastric variceal bleeding. Splenectomy, splenic artery embolization, and stenting of the splenic vein are the current treatment choices. In this patient, chemotherapy was an alternative treatment, and the splenic vein occlusion resolved after the lymphoma regressed.