Multiple giant splenic artery aneurysms causing sinistral. Portal hypertension schistosomiasis congenital heart disease chd persistent pulmonary hypertension of the newborn pphn 1 pulmonary venoocclusive disease andor pulmonary capillary hemangiomatosis the 20 nice classification of pah 5th wsph pulmonary venous hypertension 2 heart failure normal or low ef. Case report multiple giant splenic artery aneurysms causing. The liver contour is smooth and spleen size is normal. View media gallery venous phase of a digital subtraction superior mesenteric angiogram same patient as in the previous image shows a normal portal vein pv with no streaming effect from splenic venous flow arrow, suggestive of splenic vein thrombosis. Acute pancreatitis associated leftsided portal hypertension. Aug 18, 2020 left sided portal hypertension lsph is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. Sinistral or left sided portal hypertension lsph is a rare entity, different from generalized portal hypertension due to confinement to left side portal system only. An oversized pdf file can be hard to send through email and may not upload onto certain file managers. Diagnosis and treatment of pulmonary hypertension american. This article is published with open access at abstract.
Caitilin kelly, md, is boardcertified in internal medicine. You lie on your left side, referred to as the left lateral position. Leftsided portal hypertension secondary to pancreatic cancer. Cirrhosis a form of chronic liver failure is the most common cause of portal hypertension. Case report pancreatic mass leading to leftsided portal. Left sided portal hypertension secondary to pancreatic cancer. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression.
Significance of simultaneous splenic artery resection in left. Among the causes of extrahepatic portal hypertension, trauma, hypercoagulability, longterm oral contraceptives, infections, congenital anomalies are. As the condition progresses, there is a rise in portal blood. Leftsided portal hypertension caused by peripancreatic.
Portal hypertension is a complication of liver disease. Pdf splenomegaly and left sided portal hypertension. Splenic veininferior mesenteric vein anastomosis to. Guidelines are developed by a multidisciplinary panel of experts who rate the quality level of the evidence and the strength of each recommendation using the grading of recommendations assessment, development, and evaluation system.
Concejero,2 chaolong chen,2 and yufan cheng1 splenic vein thrombosis with gastric variceal bleeding is dif. The most common cause of portal hypertension is cirrhosis, or scarring of the liver. The diagnosis of pah requires confirmation with a complete right heart. Isolated splenic vein thrombosis left sided portal hypertension is usually secondary to pancreatic inflammation or neoplasm. Sinistral left sided portal hypertension is a clinical syndrome in the setting of splenic vein thrombosis due to a primary pancreatic pathology. Yalin k, hongyi z, xiaojun h, chengli l, mei x, di w, gang z, yuying z. Sinistral portal hypertension also known as left sided portal hypertension or segmental portal hypertension is an uncommon form of portal hypertension clinical presentation. Splenic vein thrombosis remains most common cause of lsph 1, 2. Table of contents cirrhosis is a form of liver disease. Sinistral leftsided extrahepatic portal hypertension. The exact incidence of left sided portal hypertension is unknown as it is rarely found, approximately 15%, and most cases were misdiagnosed. In such patients, splenectomy is traditionally considered as the treatment of choice to relieve venous hypertension. Sinistral portal hypertension radiology reference article. Your doctor can visualize the esophagus, stomach and duodenum with the endoscope.
Pancreatic mass leading to left sided portal hypertension, causing bleeding from isolated gastric varices helgathrainsdottir, 1,2 vigdispetursdottir, 3 sigurdurblondal, 4 andeinars. Left sided portal hypertension caused by idiopathic splenic vein stenosis improved by splenectomy. Pancreatic cancer is notorious for presenting with vague and nonspecific symptoms, including but not exclusively weight loss, abdominal pain, and anorexia with or without jaundice. As a very rare finding we describe a patient who presented with an exorbitant left sided varicocele due to portal hypertension. Secondary to large pancreatic tumor invading splenic vein. Features of lsph secondary to pancreatic cancer is ambiguous, and controversy remains in the treatment. Splenic vein occlusion results in left sided portal hypertension characterized by gastric varices, splenomegaly and normal liver function 911 that is secondary to various diseases 1214. Of great importance in its development are pancreatic cancer 18%, pancreatitis 65%, pseudocysts and pancreatectomy. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Variceal bleeding in liver recipient with left sided portal hypertension hsinyou ou,1 tungliang huang,1 taiyi chen,1 leo leungchit tsang,1 allan m.
I paid for a pro membership specifically to enable this feature. Congestive hepatopathy, is liver dysfunction due to venous congestion, usually due to congestive heart failure. Preservation of right gastroepiploic vein to lessen left. Portal hypertension is a term used to describe elevated pressures in the portal venous system a major vein that leads to the liver. Blood then leaks into the abdomen and causes ascites. Portal hypertension may be caused by intrinsic liver disease, obstruction, or structural changes that result in increased portal venous flow or increased hepatic resistance. To combine pdf files into a single pdf document is easier than it looks.
The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. Pdf file or convert a pdf file to docx, jpg, or other file format. Secondary left sided portal hypertension and radical operations and prognosis in pancreatic cancer cases 0 25. Leftsided portal hypertension caused by idiopathic. Pdf is a hugely popular format for documents simply because it is independent of the hardware or application used to create that file. Bjornsson 1,2 section of gastroenterology, department of internal medicine, e national university hospital of iceland, hringbraut, reykjavik, iceland. Left sided portal hypertension lsph, also known as segmental, regional, localized, compartmental, lineal, splenoportal, or sinistral hypertension is a rare, but life threatening cause of upper gastrointestinal bleeding. Extrahepatic portal hypertension is the most common cause of portal hypertension cavernomatous transformation of the portal vein centripetal distribution of the collaterals. Splenic artery aneurysm was thought to be the cause of portal hypertension. Apr 07, 2017 the final diagnosis was left sided portal hypertension secondary to splenic vein thrombosis.
Leftsided portal hypertension lsph is a localized form of portal hypertension that usually occurs as a result of iso lated obstruction of the splenic vein 1, 2. Hepatic hydrothorax is a less common complication of portal hypertension, with a prevalence of only 5% to 10%. Portal hypertension is an increase in the pressure within the portal vein, which carries blood from the digestive organs to the liver. Isolated lesion of the splenic vein causes left sided portal hypertension. Ishikawa h, okadome j, yamamura m, nakame a, shirouzu y, muroya d, et al. Pdf role of splenic artery embolization in gastric. Left sided portal hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. Leftsided portal hypertension caused by peripancreatic lymph. The aim of this study was to evaluate how often leftsided portal hypertension lph develops and how lph affects the longterm outcomes of patients with pancreatic cancer treated with pancreaticoduodenectomy pd and resection of the portal vein pvsuperior mesenteric vein smv confluence summary background data. This article explains what pdfs are, how to open one, all the different ways. Left sided portal hypertension lsph is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. Portal hypertension is abnormally increased portal venous pressure blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Ultrasound signs of portal hypertension competently about.
Pulmonary hypertension associated with lung diseases andor hypoxemia 3. The most common symptoms are ascites and variceal hemorrhage, which develop in 47% and 25% of patients, respectively. Significance of simultaneous splenic artery resection in. Leftsided portal hypertension secondary to pancreatic. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy ls. Splenic artery aneurysm causing sinistral portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm 7. Sinistral or left sided portal hypertension is a localized form of portal hypertension usually due to isolated obstruction of splenic vein. The aim of this study was to evaluate how often leftsided portal hypertension lph develops and how lph affects the longterm outcomes of patients with pancreatic cancer treated with pancreaticoduodenectomy pd and resection of the portal vein pvsuperior mesenteric vein smv confluence. Case report multiple giant splenic artery aneurysms.
Symptoms and causes what causes portal hypertension. Leftsided portal hypertension, digestive diseases and. Secondary left sided portal hypertension and radical operations and prognosis in pancreatic cancer cases asian pac j cancer prev, 15 5, 22392244 introduction on the radical operation rate of patients with pancreatic left sided portal hypertension lsph, also known as sinistral or segmental portal hypertension, is associated. She was thus diagnosed with le sided portal hypertension. Hypertension may also be a side effect of certain medications, such as overthecounter cold medications and oral contraceptives and other hormone drugs. Most electronic documents such as software manuals, hardware manuals and ebooks come in the pdf portable document format file format. The most common cause is cirrhosis of the liver, but thrombosis clotting might also be the cause.
Portal hypertension can be quite serious, though its treatable if diagnosed in time. Endoscopic color doppler ultrasonographic evaluation of. Leftsided portal hypertension caused by idiopathic splenic. Emergency splenic arterial embolization for massive. Sinistral portal hypertension also known as left sided portal hypertension or segmental portal hypertension is an uncommon form of portal hypertension. Nov 01, 2015 sinistral portal hypertension sph is also known as splenoportal, left sided, segmental, regional, localized, compartmental or lineal portal hypertension. Left sided portal hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. Get the latest news and education delivered to your inbox 2020 healio all rights reserved. We reported 3 cases of left sided portal hypertension in male patient aged 34 years old, female patient aged 29 years old, and female patient aged 35 years old. Its cause is unknown although omphalitis, peritonitis, exchange transfusions via the umbilical vein, or distant sepsis have occurred during the neonatal period in a few patients. Pancreatic mass leading to leftsided portal hypertension.
These constitute less than 5% of all the cases of portal hypertension. Left sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. Its high blood pressure that affects the portal veins leading from the intestines to the liver. Cirrhosis is the most common cause of portal hypertension. Rarely this can present as lifethreatening gastric variceal bleeding. Luckily, there are lots of free and paid tools that can compress a pdf file in just a few easy steps.
In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions. Specific symptoms are often lacking, rendering it difficult to diagnose. Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse or other causes of liver damage. Jan 01, 2014 left sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. Learn about the causes, symptoms, risk factors, and t. Splenic artery embolization as an adjunct to surgery in a. The occurrence of left sided portal hypertension was evaluated in both groups before and after surgery by assessing the platelet count and spleen volume according to the cavalieri method. It usually occurs as a result of isolated obstruction of the splenic vein. When it becomes severe enough to cause symptoms or complications, treatment may be. Preservation of right gastroepiploic vein to lessen left sided portal hypertension after conversion pancreaticoduodenectomy with concomitant vascular resection after chemotherapy for a locally advanced pancreatic cancer. In symptomatic patients, the most common presentation although rare is gastrointestinal bleeding from esophageal or gastric. Portal hypertension is a complication of endstage liver disease.
Portal hypertension surgical management slideshare. Radiologic evaluation showed splenomegaly, splenic vein obstruction, and multiple aneurysms along the splenic artery ranging from. Among many, pancreatic lesions are the most common cause of portal vein obstructionocclusion leading to lsph. If your pdf reader is displaying an error instead of opening a pdf file, chances are that the file is c. In cases where gastrointestinal gi bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. Read on to find out just how to combine multiple pdf files on macos and windows 10. Sinistral portal hypertension sph is also known as splenoportal, left sided, segmental, regional, localized, compartmental or lineal portal hypertension. Left ventricular heart failure and pulmonary hypertension. It occurs when cells in your liver become damaged beyond repair. Splenic artery aneurysm causing sinistral portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. A pdf file is a portable document format file, developed by adobe systems.
Your doctor inserts the endoscope a thin, flexible, lighted tube with a camera through your mouth and pharynx, into the esophagus. Portal hypertension is defined as a hepatic venous pressure gradient greater than 5 mmhg. A rare syndrome, sinistral left sided portal hypertension resulting from splenic vein thrombosis secondary to pancreatic adenocarcinoma of the tail is presented here. This means it can be viewed across multiple devices, regardless of the underlying operating system. Although splenic vein stenosis or occlusion is often caused by trauma, pancreatitis. Pancreatic adenocarcinoma presenting as sinistral portal. Left sided portal hypertension after pancreaticoduodenectomy with combined portal vein resection kazuyuki gyoten1 shugo mizuno1 motonori nagata2 toru ogura3 masanobu usui1 shuji isaji1 published online. This causes swelling in the abdomen and sometimes the legs. Left sided portal hypertension lsph followed by acute pancreatitis is a rare condition with most patients being asymptomatic.
The gross pathological appearance of a liver affected by chronic passive congestion is speckled like a grated nutmeg kernel. Little is known about lph after pd with resection of the. Side to side portocaval shunt hepatofugal portal flow. Variceal bleeding due to extrahepatic portal hypertension may be first manifested at any age.
By michelle rae uy 24 january 2020 knowing how to combine pdf files isnt reserved. Normally, blood from the gi tract, spleen, and pancreas flows to the liver via the portal vein, then moves into the vena cava for return to the heart. Hiv, portal hypertension, hemoglobinopathies, and myeloproliferative disorders. Left sided portal hypertension lsph is characterized by the flow of splenic venous blood into the portal trunk via the collateral circulation due to narrowing or obstruction of the splenic vein. Splenic artery aneurysm was thought to be the cause of portal hypertension and hypersplenism.
473 1715 995 163 1163 1442 1221 1387 1601 1566 1627 749 596 863 1327 996 881 1308 1263 983 883 1334 809 868 136 1618 503 193 1670 15 63 1309