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Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion
Authors:Bao-Chung Chen  Hong-Hau Wang  Yu-Chieh Lin  Yu-Lueng Shih  Wei-Kuo Chang  Tsai-Yuan Hsieh
Affiliation:Bao-Chung Chen, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, TaiwanHong-Hau Wang, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, TaiwanYu-Chieh Lin, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Abstract:Isolated gastric varices (IGV) can occur in patients with left-sided portal hypertension resulting from splenic vein occlusion caused by thrombosis or stenosis. In left-sided portal hypertension, blood flows retrogradely through the short and posterior gastric veins and the gastroepiploic veins, leading to the formation of an IGV. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. Our patient presented with a rare case of IGV bleeding induced by splenic lymphoma-associated splenic vein occlusion. Splenectomy, splenic artery embolization, and stenting of the splenic vein are the current treatment choices. Chemotherapy, however, is an alternative effective treatment for splenic vein occlusion caused by chemotherapy-sensitive tumors. Our patient responded well to chemotherapy with a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone regimen, and the splenic vein occlusion resolved after the lymphoma regressed.
Keywords:Isolated gastric varices   Splenic vein   Lymphoma   Occlusion   Hematemesis
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