Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis:A case report and literature review  

作　　者：Lisa-Michaela Füssel Rene Müller-Wille Patrick Dinkhauser Walter Schauer Harald Hofer 

机构地区：[1]Department of Internal Medicine Ⅰ,Gastroenterology and Hepatology,Klinikum Wels-Grieskirchen,Wels 4600,Austria [2]Department of Radiology,Klinikum Wels-Grieskirchen,Wels 4600,Austria [3]Department of Abdominal Surgery,Klinikum Wels-Grieskirchen,Wels 4600,Austria

出　　处：《World Journal of Gastroenterology》2023年第24期3922-3931,共10页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

关 键 词：Pancreatitis-induced splenic vein thrombosis Gastrointestinal hemorrhage Colonic varices Splenic vein stenting Segmental/sinistral hypertension Case report 

分 类 号：R57[医药卫生—消化系统]