Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review

Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for trea...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2023-06, Vol.29 (24), p.3922-3931
Main Authors: Füssel, Lisa-Michaela, Müller-Wille, Rene, Dinkhauser, Patrick, Schauer, Walter, Hofer, Harald
Format: Article
Language:English
Subjects:
Acute Disease
Case Report
Esophageal and Gastric Varices - diagnostic imaging
Esophageal and Gastric Varices - etiology
Esophageal and Gastric Varices - therapy
Female
Gastrointestinal Hemorrhage - diagnostic imaging
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Humans
Middle Aged
Pancreatitis - complications
Portal Vein - diagnostic imaging
Splenic Diseases
Splenic Vein - diagnostic imaging
Tomography, X-Ray Computed
Varicose Veins - complications
Venous Thrombosis - diagnostic imaging
Venous Thrombosis - etiology
Venous Thrombosis - therapy
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Summary:Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option. A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up. Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v29.i24.3922