Stepwise partial splenic embolization for portal hypertension based on a new concept: Splanchnic caput Medusae

Radiology Case Reports

Niranjan Sharma, MD¹  Kai Mizobuchi²  Satoshi Ito, MD³  Koji Ueta, MD⁴  Hiromichi Yamai, MD⁵  Hisashi Matsuoka, MD⁵  Fumio Chikamori, MD⁵  Sawaka Yukishige⁵  Nobumasa Hamaguchi, MD⁵  Nobuyuki Tanida, MD⁵  Kazuhisa Onishi, MD⁵  Haruka Takasugi⁵  Norihiro Hokimoto, MD⁵ 

[1] Corresponding author.;Organ Transp Surgery, 12 Scotland Street Dunedin, 9016, New Zealand;;Adv Train Gastroint &Department of Radiology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan;Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan;

关键词: Splanchnic caput Medusae;    Partial splenic embolization;    Endoscopic injection sclerotherapy with ligation;    Retrograde obliteration;    Portal hypertension;    Liver fibrosis;   

DOI  :  

来源: DOAJ

【 摘 要 】

Management of splenomegaly with thrombocytopenia is important in the treatment of portal hypertension. We propose a new concept: “Splanchnic Caput Medusae” in which enlarged spleen is her face and portal collateral pathways are her snake hairs. We report 2 demonstrable cases who were treated based on this new concept. Case 1 with refractory esophageal varices and splenomegaly was treated by stepwise partial splenic embolization (PSE) and endoscopic injection sclerotherapy with ligation. Spleen/liver volume ratio changed from 0.33 to 0.10. Hepatic venous pressure gradient changed from 19 to 14 mmHg. Case 2 with mesenteric shunt and splenomegaly was treated by stepwise PSE and retrograde obliteration. Spleen/liver volume ratio changed from 0.70 to 0.05. Hepatic venous pressure gradient changed from 11 to 7 mmHg. In these 2 cases, 3D-CT reconstruction images after treatment revealed that spleen- portal system reversed almost to normal form. We conclude that splenomegaly and portal collateral pathways could be considered as “Splanchnic Caput Medusae” and have to be treated by stepwise PSE.

【 授权许可】

Unknown