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

von Trotha KT, Binnebösel M, Truong S, Behrendt FF, Wasmuth HE, Neumann UP, Jansen M - BMC Surg (2011)

Bottom Line: 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 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall.Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital of the RWTH Aachen, Germany. kvontrotha@ukaachen.de

ABSTRACT

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 12th 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.

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Endoscopic colour duplex sonography showing arterial flow on the apparently gastric varices.
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Figure 4: Endoscopic colour duplex sonography showing arterial flow on the apparently gastric varices.

Mentions: In order to prove that the submucosal vessels were indeed arterial collaterals, a gastrointestinal endoscopy of the stomach using color-duplex ultrasound was performed. Multiple arterial vessels, but no venous collaterals, could be identified in the gastric fundus (Figure 4).


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

von Trotha KT, Binnebösel M, Truong S, Behrendt FF, Wasmuth HE, Neumann UP, Jansen M - BMC Surg (2011)

Endoscopic colour duplex sonography showing arterial flow on the apparently gastric varices.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3142481&req=5

Figure 4: Endoscopic colour duplex sonography showing arterial flow on the apparently gastric varices.
Mentions: In order to prove that the submucosal vessels were indeed arterial collaterals, a gastrointestinal endoscopy of the stomach using color-duplex ultrasound was performed. Multiple arterial vessels, but no venous collaterals, could be identified in the gastric fundus (Figure 4).

Bottom Line: 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 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall.Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital of the RWTH Aachen, Germany. kvontrotha@ukaachen.de

ABSTRACT

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 12th 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.

Show MeSH
Related in: MedlinePlus