Published online Oct 16, 2015. doi: 10.12998/wjcc.v3.i10.920
Peer-review started: March 28, 2015
First decision: May 18, 2015
Revised: June 11, 2015
Accepted: September 2, 2015
Article in press: September 25, 2015
Published online: October 16, 2015
Gastric varices (GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension (also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis (the splenic artery - after a short gastric vein or stomach vein - gastric coronary vein - portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed pathology and blood rheology data are available.
Core tip: Here, we report a case in which chronic pancreatitis-induced complete splenic vein thrombosis led to intractable gastric variceal bleeding, which is effectly treated by splenectomy. We have provided details regarding the imaging and pathology data, and we describe the hemodynamic characteristics. Then, we reviewed the disease onset and treatment methods, which may provide a reference for the clinical diagnosis and treatment of similar patients.