Splenic venous hypertension presenting as variceal hemorrhage caused by portal hypertension
Rozenblit, G.; Del Guercio, L.R.; Savino, J.; Cerabona, T.; Policastro, A.; McPhee, M.
Journal of the American College of Surgeons 182(1): 63-68
1996
ISSN/ISBN: 1072-7515 PMID: 8542092 Document Number: 459512
Splenic venous hypertension (SVH) may cause variceal hemorrhage that is clinically indistinguishable from similar bleeding caused by portal hypertension (PH). This may lead to erroneous treatment, including inappropriate portosystemic shunt placement. A retrospective review of 58 cases of variceal hemorrhage referred for transmesenteric variceal sclerotherapy and transvenous intrahepatic portosystemic shunt (TIPS) placement revealed that seven patients had SVH as a cause of bleeding, and required treatment other than TIPS. The role of medical imaging in the diagnosis and management of SVH was analyzed. Clinical data did not permit a differential diagnosis between PH and SVH as the cause of bleeding in all cases. Splenic venous hypertension was suspected and then confirmed exclusively by contrast-enhanced computed tomography (CT) and angiography, which are essential for correct patient management. Computed tomography should be routinely performed to exclude SVH before TIPS placement. In instances in which CT fails to establish the diagnosis or splenic artery occlusion is considered for patient management, angiography may be used.