Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

BMC Surgery

Marc Jansen¹  Ulf P Neumann³  Hermann E Wasmuth²  Florian F Behrendt⁴  Son Truong³  Marcel Binnebösel³  Klaus T von Trotha³ 

[1] Department of Surgery, HELIOS Hospital Emil von Behring Berlin, Germany;Department of Medicine III, University Hospital of the RWTH Aachen, Germany;Department of Surgery, University Hospital of the RWTH Aachen, Germany;Department of Diagnostic Radiology, University Hospital of the RWTH Aachen, Germany

关键词: duplex ultra sound;    splenectomy;    laparoscopy;    upper gastrointestinal bleeding;    Splenic artery thrombosis;   

Others  :  1123452
DOI  :  10.1186/1471-2482-11-14

 received in 2010-09-06, accepted in 2011-06-28,  发布年份 2011

【 摘 要 】

Background

Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage.

Case presentation

In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12^th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient.

Conclusion

Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

【 授权许可】

   
2011 von Trotha et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]van Leerdam ME: Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008, 22:209-224.
• [2]Dror S, Dani BZ, Ur M, Yoram K: Spontaneous thrombosis of a splenic pseudoaneurysm after blunt abdominal trauma. J Trauma 2002, 53:383-385.
• [3]Gow KW, Murphy JJ, Blair GK, Stringer DA, Culham JA, Fraser GC: Splanchnic artery pseudo-aneurysms secondary to blunt abdominal trauma in children. J Pediatr Surg 1996, 31:812-815.
• [4]Kalra BS, Chaturvedi S, Tayal V, Gupta U: Evaluation of gastric tolerability, antinociceptive and antiinflammatory activity of combination NSAIDs in rats. Indian J Dent Res 2009, 20:418-422.
• [5]Redeen S, Petersson F, Kechagias S, Mardh E, Borch K: Natural history of chronic gastritis in a population-based cohort. Scand J Gastroenterol 2010, 45((5)):540-9.
• [6]Garcia-Tsao G, Lim JK: Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol 2009, 104:1802-1829.
• [7]Moore KP, Aithal GP: Guidelines on the management of ascites in cirrhosis. Gut 2006, 55(Suppl 6):vi1-12.
• [8]Navarro VJ, Garcia-Tsao G: Variceal hemorrhage. Crit Care Clin 1995, 11:391-414.
• [9]Baron PW, Sindram D, Suhocki P, Webb DD, Clavien PA: Upper gastrointestinal bleeding from gastric submucosal arterial collaterals secondary to splenic artery occlusion: treatment by splenectomy and partial gastric devascularization. Am J Gastroenterol 2000, 95:3003-3004.
• [10]Cyrany J, Kopacova M, Rejchrt S, Jirkovsky V, Al-Tashi M, Bures J: Gastric arterial bleeding secondary to chronic occlusion of the splenic artery (with video). Gastrointest Endosc 2010, 71:1335.
• [11]Mnatzakanian G, Smaggus A, Wang CS, Common AA, Jeejeebhoy KN: Splenic artery collaterals masquerading as gastric fundal varices on endoscopy: a sticky situation. Gastrointest Endosc 2008, 67:751-755.
• [12]Durrans D, Fawcitt RA, Taylor TV: Congenital absence of the splenic artery associated with major gastric bleeding in adolescence. Br J Surg 1985, 72:456-457.
• [13]Spriggs DW: Congenital absence of the splenic artery. Cardiovasc Intervent Radiol 1984, 7:303-305.
• [14]Mogl MT, Nussler NC, Presser SJ, Podrabsky P, Denecke T, Grieser C, Neuhaus P, Guckelberger O: Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transpl Int 2010.
• [15]Vogl TJ, Pegios W, Balzer JO, Lobo M, Neuhaus P: [Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries]. Rofo 2001, 173:908-913.
• [16]Vincent M, Lerat F, Trogrlic S, Laurent V, Feray C, Dupas B: [Left renal vein thrombosis following sclerotherapy for gastric varices]. J Radiol 2009, 90:745-746.
• [17]Yu LK, Hsu CW, Tseng JH, Liu NJ, Sheen IS: Splenic infarction complicated by splenic artery occlusion after N-butyl-2-cyanoacrylate injection for gastric varices: case report. Gastrointest Endosc 2005, 61:343-345.
• [18]Amouroux C, Cervoni JP, Delabrousse E, Koch S, Thevenot T, Di M V: [Portal vein thrombosis after cyanoacrylate injection therapy in bleeding gastric varices]. Gastroenterol Clin Biol 2009, 33:205-207.
• [19]Vormittag R, Simanek R, Ay C, Dunkler D, Quehenberger P, Marosi C, Zielinski C, Pabinger I: High factor VIII levels independently predict venous thromboembolism in cancer patients: the cancer and thrombosis study. Arterioscler Thromb Vasc Biol 2009, 29:2176-2181.
• [20]Tripodi A, Primignani M, Chantarangkul V, Dell'Era A, Clerici M, de FR, Colombo M, Mannucci PM: An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology 2009, 137:2105-2111.
• [21]Sugita C, Yamashita A, Moriguchi-Goto S, Furukoji E, Takahashi M, Harada A, Soeda T, Kitazawa T, Hattori K, Tamura S, Asada Y: Factor VIII contributes to platelet-fibrin thrombus formation via thrombin generation under low shear conditions. Thromb Res 2009, 124:601-607.