Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization |
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Authors: | Damiano Patrono Rosa Benvenga Francesco Moro Denis Rossato Renato Romagnoli Mauro Salizzoni |
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Institution: | aGeneral Surgery 2U and Liver Transplantation Center, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy;bRadiology Department, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy |
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Abstract: | INTRODUCTIONLeft-sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy (LS). Although some studies have reported the feasibility of the laparoscopic approach in the setting of cirrhosis-related portal hypertension, experience concerning LS in left-sided portal hypertension is lacking.PRESENTATION OF CASEA 39-year-old man was admitted to the Emergency Department for haemorrhagic shock due to acute hemorrhage from gastric fundus varices. Diagnostic work up revealed a chronic pancreatitis-related splenic vein thrombosis causing left-sided portal hypertension with gastric fundus varices and splenic cavernoma. Following splenic artery embolization (SAE), the case was successfully managed by LS.DISCUSSIONThe advantages of laparoscopic over open splenectomy include lower complication rate, quicker recovery and shorter hospital stay. Splenic artery embolization prior to LS has been used to reduce intraoperative blood losses and conversion rate, especially in complex cases of splenomegaly or cirrhosis-related portal hypertension. We report a case of complicated left-sided portal hypertension managed by LS following SAE. In spite of the presence of large varices at the splenic hilum, the operation was performed by laparoscopy without any major intraoperative complication, thanks to the reduced venous pressure achieved by SAE.CONCLUSIONSplenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy. |
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Keywords: | Laparoscopic splenectomy Splenic artery embolization Portal hypertension Left-sided portal hypertension Splenic cavernoma |
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