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. It is the result of resistance to portal blood flow and may lead to complications such as variceal bleeding and ascites. New delhi, india summary sinistral portal hypertension is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis due to a. Mucinous cystic neoplasms mcn are an uncommon form of exocrine neoplasms of the pancreas. The portal vein receives blood from the entire intestine and. Publications home of jama and the specialty journals of the. Portal hypertension often develops in the setting of cirrhosis, schistosomiasis, or extrahepatic portal vein thrombosis. In this patient, a thrombotic stenosis of the reconstructed left portal vein anastomosis diagnosed in a mri examination 6 months after the operation as demonstrated in additional file 1. Sinistral, or leftsided, portal hypertension sph is a rare entity, with. 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. Portal hypertension causes, symptoms, treatments, tests. Portal vein embolization pve is a preoperative procedure performed in interventional radiology to initiate hypertrophy of the anticipated future liver remnant a couple weeks prior to a major liver resection procedure. The procedure involves injecting the right or left portal vein with embolic material to occlude portal blood flow. Pancreatic mass leading to leftsided portal hypertension.
A case report dinesh singhal, rahul kakodkar, arvinder s soin, subash gupta, samiran nundy department of surgical gastroenterology, sir ganga ram hospital. Sinistral portal hypertension sph is also known as splenoportal, left sided, segmental, regional, localized, compartmental or lineal portal hypertension. Congestive heart failure heart failure chf medlineplus. Endoscopy showed a normal esophagus, but multiple polypoid submucosal lesions were seen in the fundus and body of the stomach. Imaging and doppler of portal hypertension myron a. Diuretics potassium sparing diuretics is considered the diuretic of choice in portal hypertension. The final diagnosis was leftsided portal hypertension secondary to splenic vein thrombosis. While the validity of these surrogate markers of portal hypertension has been documented in patients with chemotherapyinduced hepatic sinusoidal injury and generalized portal hypertension, it is not clear whether they are equally applicable or reliable in the setting of pure left sided portal hypertension. Leftsided portal hypertension, digestive diseases and. A 23yearold female patient presented to our clinic with gastric varices, splenomegaly, pancytopenia, and normal. The aim of this study was to evaluate how often left sided 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. The main aim of the present study is to summarize the clinical features of patients with sph.
The primary pathology usually arises in the pancreas and results in compression of the pancreatic. Hvpg is a surrogate for the portosystemic pressure gradient. Leftsided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. Interactions of the heart and the liver european heart. Sph differs from other forms of portal hypertension in that liver function is often. Veins coming from the stomach, intestine, spleen, and pancreas merge into the. The current case is one of three cases yet reported where the mcn caused left sided portal hypertension leading to the formation of isolated gastric varices and subsequent bleeding from the varices.
Diagnosis is difficult and requires a high index of suspicion, especially in patients presenting with gastrointestinal bleed in the presence of splenomegaly and normal liver function tests. Pancreatic adenocarcinoma presenting as sinistral portal. Portal hypertension is abnormally high blood pressure in the portal vein the large vein that brings blood from the intestine to the liver and its branches. Jan 25, 2019 the portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. Sinistral, or leftsided, portal hypertension sph is a rare cause of upper gastrointestinal hemorrhage. In 1902, gilbert and carnot introduced the term portal hypertension to describe this. Sinistral, or left sided, portal hypertension sph is a rare entity, with multiple potential causes. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy ls. Other synonymous terminologies referring to sisnistral portal hypertension are left sided portal hypertension, segmental, regional, localized, compartmental, lineal, or splenoportal hypertension. Portal hypertension and gross splenomegaly in uganda.
When signs of portal hypertension were seen, endoscopy is needed to. A rare syndrome, sinistral leftsided portal hypertension resulting from splenic vein thrombosis secondary to pancreatic adenocarcinoma of the tail is presented here. Portal hypertension is hypertension high blood pressure in the hepatic portal system made up of the portal vein and its branches, that drain from most of the intestine to the liver. Leftsided portal hypertension is rarely found, but this condition may cause gastrointestinal tract bleeding and can be lifethreatening. Consider repair of defect if significant lefttoright shunt.
Primary pulmonary hypertension is a rare disease of unknown etiology, whereas sec ondary pulmonary hypertension is a complication of many pulmonary, cardiac. Leftsided 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. The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. Ppt hypertension powerpoint presentation free to download. Gastrointestinal hemorrhage from left sided portal hypertension an unappreciated complication of pancreatitis alex g. Pulmonary venous hypertensionmost common cause usually due to leftsided heart disease valvular, coronary or myocardial, obstruction to blood flow downstream from the pulmonary veins. Causes of sph were chronic pancreatitis n 7, acute pancreatitis n. Abstractintroductionsinistral, or leftsided, portal hypertension sph is a rare entity, with multiple potential causes. Leftsided portal hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. Gastrointestinal hemorrhage from leftsided portal hypertension. In 1902, gilbert and carnot introduced the term portal hypertension to describe this condition. Increased pressure in the portal vein causes large veins varices to develop across the esophagus and stomach to.
It is rare for them to cause sinistral portal hypertension. Variceal bleeding due to extrahepatic portal hypertension may be first manifested at any age. Heart failure is a condition in which the heart cant pump enough blood to meet the bodys needs. It usually occurs as a result of isolated obstruction of the splenic vein. Figure s1 after rightsided extended hemihepatectomy was the triggering reason for the portal hypertension. Sinistral, or leftsided, portal hypertension is a rare cause of upper gastrointestinal haemorrhage. Vascular resistance and blood flow are the 2 important factors in its development. Splenomegaly, one of the symptoms of portal hypertension, is an enlargement of the spleen caused by a decrease in blood flow through the splenic vein. Although some studies have shown the feasibility of laparoscopic splenectomy in patients suffering from cirrhosisrelated portal hypertension,5, 6, 7 the setting of. Pozniak, md professor of radiology university of wisconsin madison, wisconsin nothing to disclose relevant to this presentation. A dilated portal vein diameter of greater than or 15 mm is a sign of portal hypertension, with a sensitivity estimated at 12.
Cirrhosis a form of chronic liver failure is the most common cause of portal hypertension. Rahim moossa, md, frcs, facs, chicago, illinois upper gastrointestinal bleeding from gastroesoph ageal varices secondary to splenic vein thrombosis caused by pancreatitis is being recognized with in creasing frequency. Splenic artery aneurysm is the most common type of visceral aneurysms. The most common cause of portal hypertension is cirrhosis. Pathophysiology of portal hypertension jaime bosch, m. Portal hypertension can be quite serious, though its treatable if diagnosed in time.
Consider repair of defect if significant left toright shunt. It means that your heart is not able to pump blood the way it should. Portal hypertension remains one of the most serious sequelae of chronic liver disease. Sinistral portal hypertension sph is also known as splenoportal, leftsided, segmental, regional, localized, compartmental or lineal portal hypertension. Clinically significant portal hypertension is defined as an hepatic venous pressure gradient of 10 mm hg or more. Nov 30, 2017 the most common cause of portal hypertension is cirrhosis. Primary pulmonary hypertension is a rare disease of unknown etiology, whereas sec ondary pulmonary hypertension is a complication of many pulmonary, cardiac and extrathoracic conditions. Of course we cannot say for sure what caused the portal hypertension. Endoscopic findings in a 47yearold man with a history of polycythemia rubra vera who had a recent episode of hematemesis. Pulmonary hypertension associated with lung diseases andor hypoxemia 3. Leftsided portal hypertension lsph, also known as segmental, regional. Pdf splenomegaly and left sided portal hypertension. Hypothesis a splenic vein svinferior mesenteric vein imv anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the svmesenteric vein confluence but carries a risk of leftsided venous hypertension.
Left ventricular heart failure and pulmonary hypertension. Symptoms of portal hypertension are caused by the complications of decreased blood flow through the liver and increased pressure within veins where blood is shunted. In fact, the name sinistral portal hypertension is a misnomer since portal pressure is usually within the normal range in these cases 1,3. Causes pre hepatic portal vein thrombosis splenic vein thrombosis left sided pht hepatic presinusoidal schistosomiasis, nonalcoholic cirrhosis sinusoidal alcoholic cirrhosis posthepatic buddchiari, constrictive pericarditis, right heart failure. Isolated splenic vein thrombosis with left sided portal hypertension is a rare cause of upper gastrointestinal bleed. Multiple giant splenic artery aneurysms causing sinistral. 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. Leftsided portal hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. The current case is one of three cases yet reported where the mcn caused leftsided portal hypertension leading to the formation of isolated gastric varices and subsequent bleeding from.
The images below depict esophageal varices, which are responsible for the main complication of portal hypertension, upper gastrointestinal gi hemorrhage. 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. They are usually asymptomatic and have a potential for rupture and therefore lifethreatening hemorrhage. Left sided portal hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. Leftsided portal hypertension lsph refers to a rare type of extrahepatic portal hypertension secondary to the obstruction or stenosis of splenic vein 1. It may be difficult to diagnose this entity both endoscopically and. Left sided portal hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. This pdf file on the pharmacological management of hypertension was written by the pharmacology opencourseware initiative at harvard medical school mit. Splenomegaly and left sided portal hypertension article pdf available in annals of gastroenterology 183. Symptoms are most often vague and this makes the diagnosis more difficult. Hyperplastic malignant hypertension 22 left ventricular cardiac hypertrophy left sided hypertensive cardiomyopathy hypertensive heart disease longstanding poorly treated htn leads to left sided hypertensive heart disease.
There are many causes of sinistral portal hypertension. Portal hypertension is defined as a hepatic venous pressure gradient. Portal hypertension liver and gallbladder disorders. Portal hypertension is an increase in the pressure within the portal vein the vein that carries blood from the digestive organs to the liver. Left sided portal hypertension and isolated gastric varices igv from splenic vein thrombosis svt complicating pancreatitis and other pancreatic disorders have been described in 1545% of adults. Leftsided portal hypertension lsph, also known as segmental.
Mar 24, 2007 left sided portal hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. Aug 15, 2014 left sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. Portal vein recanalization and embolization of the. Splenic veininferior mesenteric vein anastomosis to lessen leftsided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. In this survey, the most common cause of splenic vein thrombosis was pancreatic cancer and only nine cases were clearly related to pancreatitis alone. Sinistral, or left sided, portal hypertension is a rare cause of upper gastrointestinal haemorrhage. The primary pathology usually arises in the pancreas and results in compression of the pancreatic vein. Patients parents description of that period led us to believe that she had been diagnosed with idiopathic portal hypertension since it is occasionally concomitant with huge splenic artery aneurysm and it is difficult to diagnose leftsided portal hypertension at that age. Heart failure does not mean that your heart has stopped or is about to stop working. Jul 15, 2014 portal hypertension refers to abnormally high pressure in the hepatic portal vein.
Get a printable copy pdf file of the complete article 1. The increase in pressure is caused by a blockage in the blood flow through the liver. Syndrome of splenomegaly, anaemia, and hepatomegaly often leftlobed, in south arabia. Hypertrophy of the heart is an adaptive response to pressure overload due to htn. Splenic veininferior mesenteric vein anastomosis to. Introduction as early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. Portal hypertension is defined as hepatic venous pressure gradient hvpg greater than 5 mmhg. Diagnosis and treatment of pulmonary hypertension american. On doppler ultrasonography, a slow velocity of portal vein are diagnostic of portal hypertension. Portal hypertension and bleeding esophageal varices. Clinically significant portal hypertension is defined as a gradient greater than 10 mmhg and variceal bleeding may occur at a gradient greater than 12 mmhg.
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