Abstract
Isolated splenic vein thrombosis is being recognized more frequently as a complication of pancreatic disease and as the cause of gastrointestinal hemorrhage in patients without liver disease. The increased incidence reflects advances in diagnostic radiology and a higher index of suspicion for the diagnosis.
Splenic vein thrombosis should be suspected in: (a) a patient with a history of pancreatitis and gastrointestinal blood loss; (b) a patient with splenomegaly in the absence of portal hypertension, cirrhosis, or hematologic disease; and (c) in the setting of isolated gastric varices.
Celiac angiography has replaced splenoportography as the definitive diagnostic tool for splenic vein thrombosis and is indicated prior to operation for suspected portal hypertension or for complications of pancreatitis. The importance of making the diagnosis lies in differentiating the lesion from the more common case of hepatic and extrahepatic portal hypertension. The treatment of choice is splenectomy.
Résumé
La thrombose isolée de la veine splénique est reconnue avec une plus grande fréquence qu'elle complique une affection pancréatique ou qu'elle soit la cause d'une hémorragie digestive chez des malades dont le foie est normal. Ce fait reflète les progrès dans le diagnostic radiologique et dans la connaissance de sa relative fréquence.
La thrombose de la veine splénique doit être envisagée: (a) chez un malade qui présente une histoire de pancréatite ou d'une hémorragie gastrointestinale; (b) chez un sujet porteur d'une splénomégalie en l'absence d'hypertension portale, de cirrhose ou de maladie hématologique; et (c) en présence de varices gastriques isolées.
L'angiographie coeliaque a pris la place de la splénoportographie pour porter le diagnostic; elle est indiquée avant toute opération pour hypertension portale ou pancréatite compliquée. Cette exploration capitale permet de distinguer la thrombose de la veine splénique de causes plus courantes à l'origine de l'hypertension portale d'origine hépatique ou extrahépatique. Le traitement de choix est la splénectomie.
Resumen
La trombosis aislada de la vena esplénica viene siendo reconocida con mayor frecuencia como consecuencia de enfermedad pancreática y como causa de hemorragia gastrointestinal en pacientes libres de enfermedad hepática. La aumentada incidencia es un reflejo de los avances en radiología y de un más alto índice de sospecha en el proceso diagnóstico.
Se debe sospechar la presencia de trombosis de la vena esplénica en: (a) un paciente con historia de pancreatitis y de sangrado gastrointestinal; (b) un paciente con esplenomegalia en ausencia de hipertensión portal, cirrosis o enfermedad hematológica, y (c) en presencia de várices gástricas aisladas.
La angiografía celiaca ha suplantado a la esplenoportografía como método definitivo de diagnóstico en casos de trombosis de la vena esplénica, y se halla indicado antes de la operación por sospecha de hipertensión portai y por complicaciones de la pancreatitis. La importancia de hacer el diagnóstico reside en diferenciar esta lesión de otras causas más comunes de hipertensión portal hepática y extrahepática. El tratamiento de elección es la esplenectomía.
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References
Moschowitz, E.: A critique of Banti's disease. J.A.M.A.69:1045, 1917
Hershfield, N.B., Morrow, I.: Gastric bleeding due to splenic vein thrombosis. Can. Med. Assoc. J.98:649, 1968
Greenwald, H.M., Wasch, M.G.: The roentgenologic demonstration of esophageal varices as a diagnostic aid in chronic obstruction of the splenic vein. J. Pediatr.14:57, 1939
Sutton, J.P., Yarborough, D.Y., Richards, J.T.: Isolated splenic vein occlusion. Arch. Surg.100:623, 1970
Bok, E.J., Cho, K.J., Williams, D.M., Brady, T.M., Weiss, C.A., Forrest, M.E.: Venous involvement in islet cell tumors of the pancreas. Am. J. Roentgenol.142:319, 1984
Bunt, T.J., Hackler, M.T., Greene, F.L.: Isolated splenic vein thrombosis: The curable variceal hemorrhage. South. Med. J.76:936, 1983
Burbige, E.J., Tarder, G., Carson, S., Eugene, J., Frey, C.F.: Colonic varices: A complication of pancreatitis with splenic vein thrombosis. Am. J. Dig. Dis.23:752, 1978
Cho, K.J., Martel, W.: Recognition of splenic vein occlusion. Am. J. Roentgenol.131:439, 1978
Goldberg, S., Katz, S., Naidich, J., Waye, J.: Isolated gastric varices due to spontaneous splenic vein thrombosis. Am. J. Gastroenterol.79:304, 1984
Goldstein, G.B.: Splenic vein thrombosis causing gastric varices and bleeding. Am. J. Gastroenterol.58:319, 1972
Haff, R.C., Page, C.P., Andrassy, R.J., Buckley, C.J.: Splenectomy: Its place in operations for inflammatory disease of the pancreas. Am. J. Surg.134:555, 1977
Marnar, T., Johansen, K., Haskey, R., Baker, E.: Left-sided portal hypertension from pancreatic pseudotumor. Am. J. Gastroenterol.77:639, 1982
Hondu, Y., Ueda, M., Kyoi, M., Mizunuma, T., Tukeda, R.: An unusual case of portasystemic encephalopathy caused by splenic vein occlusion following gastrectomy. Am. J. Gastroenterol.69:590, 1978
Johnston, F.R., Myers, R.T.: Etiologic factors and consequences of splenic vein obstruction. Ann. Surg.177:736, 1973
Jones, K.B., deKoos, P.T.: Postembolization splenic abscess in a patient with pancreatitis and splenic vein thrombosis. South. Med. J.77:390, 1984
Keith, R.G., Mustard, R.A., Saibil, E.A.: Gastric variceal bleeding due to occlusion of splenic vein in pancreatic disease. Can. J. Surg.25:301, 1982
Khan, A.H., O'Reilly, C.J., AvaKian, V.A., Lucina, P.A.: Splenic vein thrombosis an unusual case of gastric bleeding. Angiology28:125, 1977
Koehler, R.E.: Selected cases from the film interpretation session of the Society of Gastrointestinal Radiologists. Gastrointest. Radiol.6:365, 1981
Lavender, S., Lloyd-Davies, R.W., Thomas, M.L.: Retroperitoneal fibrosis causing localized hypertension. Br. Med. J.3:627, 1970
Law, D.K., Moore, E.E.: Compartmentalized gastrosplenic and mesenteric venous hypertension after distal splenorenal shunt occlusion: Response to mesocaval shunt and splenectomy. Surgery85:579, 1979
Little, A.G., Moossa, A.R.: Gastrointestinal hemorrhage from left-sided portal hypertension. Am. J. Surg.141:153, 1981
Longsteth, G.F., Newcomer, A.D., Green, P.A.: Extrahepatic portal hypertension caused by chronic pancreatitis. Ann. Intern. Med.75:903, 1971
Marshall, J.P., II, Smith, P.D., Hoyumpa, A.M., Jr.: Gastric varices: Problem in diagnosis. Am. J. Dig. Dis.22:947, 1977
Muhletaler, C., Gerlock, Jr, A.J., Goncharenko, V., Avant, G.R., Flexner, J.M.: Gastric varices secondary to splenic vein occlusion: Radiographic diagnosis and clinical significance. Radiology132:593, 1979
McElroy, R., Christiansen, P.A.: Hereditary pancreatitis in a kinship associated with portal vein thrombosis. Am. J. Med.52:228, 1972
Nordlinger, B.M., Fulenwider, J.T., Millikan, W.J., Warren, W.D.: Splenic artery ligation in distal splenorenal shunts. Am. J. Surg.136:561, 1978
Rice, R.P., Thompson, W.M., Keloin, F.M., Kriner, A.F., Garbutt, J.T.: Gastric varices without esophageal varices an important preendoscopic diagnosis. J.A.M.A.237:1976, 1977
Richman, L.S., Boehnke, M.: Splenic vein thrombosis: Case report. Angiology25:300, 1974
Salam, A.A., Goldman, M., Smith, D., Jr., Hill, H.L..: Gastric, intestinal and gallbladder varices: Hemodynamic and therapeutic considerations. South. Med. J.72:402, 1979
Salam, A.A., Warren, W.D., Tyras, D.H.: Splenic vein thrombosis: A diagnostic and curable form of portal hypertension. Surgery74:961, 1973
Scully, R.E., Galdabini, J.J., McNeely, B.U.: Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. N. Engl. J. Med.293:764, 1975
Stone, R.T., Wilson, S.E., Passaro, E., Jr.: Gastric portal hypertension. Am. J. Surg.136:73, 1978
Vos, L.J.M., Potocky, V., Broker, F.H.L., DeVries, J.A., Postma, L., Edens, E.: Splenic vein thrombosis with oesophageal varices: A late complication of umbilical vein catheterization. Ann. Surg.180:52, 1974
Warshaw, A.L., McChesney, T., Evans, G.W., McCarthy, H.F.: Intrasplenic dissection by pancreatic pseudocysts. N. Engl. J. Med.287:72, 1972
Wolf, J.H., Long, R.J., Miller, E.J., Jr., Jefferies, G.H.: Pancreatic islet cell tumor presenting as bleeding gastric varices secondary to splenic vein occlusion. Am. J. Dig. Dis.22:652, 1977
Yale, C.E., Crummy, A.B.: Splenic vein thrombosis and bleeding esophageal varices. J.A.M.A.217:317, 1971
Zannini, G., Musciariello, S., Pagano, G., Sangiuolo, P., Iaccarino, V.: Prehepatic portal hypertension: Experience with eighty-eight cases. Int. Surg.67:311, 1982
Khan, A.H., Martinez, N.S.: Relentless hemorrhage: Gastroesophageal varices and splenic vein thrombosis. Contemp. Surg.22:108, 1983
Burbige, E.J., Tarder, G., Carson, S., Eugene, J., Frey, C.F.: Colonic varices. A complication of pancreatitis with splenic vein thrombosis. Am. J. Dig. Dis.23:752, 1978
Sutherland, D.E.R., Goetz, F.G., Najarian, J.S.: One hundred pancreas transplants at a single institution. Ann. Surg.200:414, 1984
Salam, A.A., Warren, W.D.: Anatomic basis of the surgical treatment of portal hypertension. Surg. Clin. North Am.54:1247, 1974
Brooks, D.H.: Surgery of the spleen. Surg. Clin. North Am.55:287, 1975
Rosch, J., Herfort, K.: Contribution of splenopertography to the diagnosis of diseases of the pancreas. Acta Med. Scand.171:251, 1962
Leger, L., Lenroit, J., Lamaigre, G.: Hypertension portale segmentaire des pancreatities—Aspect angiographiques. J. Chir. (Paris)95:599, 1968
LeMaitre, G., L'Hermine, C., Maillard, J.P., Toison, F.L.: Hypertension portale segmentaire des pancreatites. Aspect angiographiques. Lille Med.16:928, 1971
Rignault, D., Mine, J., Moire, D.: Splenoportographic changes in chronic pancreatitis. Surgery63:571, 1968
Korr, S., Wohl, G.T.: Clinical importance of gastric varices. N. Engl. J. Med.263:665, 1960
Webb, L.J., Berger, L.A., Sherlock, S.: Grey scale ultrasonography of portal vein. Lancet1:675, 1977
Verbanck, J.J., Rutgeerts, L.J., Haerens, M.H., Tytgat, J.M., Segaert, M.F., Tytgat, H.J., Afschrift, M.B.: Partial splenoportal and superior mesenteric venous thrombosis early sonographic diagnosis and successful conservative management. Gastroenterology86:949, 1984
Hallenbeck, G.A., Adson, M.A.: Esophagogastric varices without hepatic cirrhosis. Arch. Surg.83:370, 1961
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Moossa, A.R., Gadd, M.A. Isolated splenic vein thrombosis. World J. Surg. 9, 384–390 (1985). https://doi.org/10.1007/BF01655272
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DOI: https://doi.org/10.1007/BF01655272