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Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Li XB, Zhao L, Liao Q, Xu Q, Zhang TP, Cong L, Mu B, Song YM, Zhao YP - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

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However, these symptoms are nonspecific, which as a consequence leads to late diagnosis as well as a low resection rate between 10% and 30%, with a 5 years overall survival rate below 10%... That how to increase early diagnosis of the pancreatic body and tail carcinoma has been a difficult problem since then... As a kind of extrahepatic portal hypertension, the main manifestations of PSPH are splenomegaly and gastrosplenic varices, without abnormalities in liver function and portal vein... PSPH is rare and curable, found in about 5–10% of the extrahepatic portal hypertension cases... The Doppler ultrasound showed splenomegaly (Stage I in 13 cases, Stage II in 5 cases, Stage III in 0 cases) and splenic vein occlusion in all 18 patients... Three-dimensional reconstruction of the portal vein by computed tomography found neither dilatation nor thrombosis of the portal vein, but had splenic vein occlusion and gastric varices in all 18 cases [Figure 1]... We found that the pancreatic body and tail carcinomas were all located within the pancreatic capsule and no sign of metastasis, normal liver, splenomegaly, and short gastric vein, gastroepiploic vein, gastric coronary vein dilated in gastrosplenic region... Surgeries in all patients were successful, and there were no mortalities... The patients were followed-up for a duration range 12–60 months, and only one nonoperative patient lost of follow-up (follow-up rate 94.4%)... All operative patients found no upper digestive tract hemorrhage and disappearance of hypersplenism after surgery... Thus, early diagnosis and therapy is of great significance to improve the prognosis of pancreatic body and tail carcinoma... The resection rate in our study was 55.5%, which was higher than other reports, indicating that early diagnosis and treatment are possible for the patients with pancreatic body and tail carcinoma manifesting gastroesophageal varices bleeding and splenomegaly... Nevertheless, the gastroesophageal varices bleeding more urgent and may cause death when bleeding happens... We conclude that the prevention and treatment of upper digestive tract bleeding in PSPH are more important in these cases... Therefore, we should aim to achieve early diagnosis and treatment as far as possible of pancreatic body and tail carcinoma patients through clinical manifestations of gastroesophageal varices (bleeding) as well as splenomegaly.

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(a) Portal vein and superior mesenteric vein are normal, no dilatation and thrombosis (b) splenic vein occlusion, gastric varices and collateral circulation formed.
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Figure 1: (a) Portal vein and superior mesenteric vein are normal, no dilatation and thrombosis (b) splenic vein occlusion, gastric varices and collateral circulation formed.

Mentions: The initial manifestations of these patients were gastroesophageal varices in 6 cases (33%), hematemesis and melena in 5 cases (28%) and splenomegaly in 7 cases (39%). The lab tests showed normal liver function in all 18 patients, hypersplenism (white blood cell [WBC] and platelet were below the normal range) in 15 cases, and serum CA199 level elevation in 16 cases. The Doppler ultrasound showed splenomegaly (Stage I in 13 cases, Stage II in 5 cases, Stage III in 0 cases) and splenic vein occlusion in all 18 patients. Three-dimensional reconstruction of the portal vein by computed tomography found neither dilatation nor thrombosis of the portal vein, but had splenic vein occlusion and gastric varices in all 18 cases [Figure 1]. Gastroscope or upper gastrointestinal radiography found gastric varices in all 18 cases, and esophageal varices in 4 cases.


Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Li XB, Zhao L, Liao Q, Xu Q, Zhang TP, Cong L, Mu B, Song YM, Zhao YP - Chin. Med. J. (2015)

(a) Portal vein and superior mesenteric vein are normal, no dilatation and thrombosis (b) splenic vein occlusion, gastric varices and collateral circulation formed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836265&req=5

Figure 1: (a) Portal vein and superior mesenteric vein are normal, no dilatation and thrombosis (b) splenic vein occlusion, gastric varices and collateral circulation formed.
Mentions: The initial manifestations of these patients were gastroesophageal varices in 6 cases (33%), hematemesis and melena in 5 cases (28%) and splenomegaly in 7 cases (39%). The lab tests showed normal liver function in all 18 patients, hypersplenism (white blood cell [WBC] and platelet were below the normal range) in 15 cases, and serum CA199 level elevation in 16 cases. The Doppler ultrasound showed splenomegaly (Stage I in 13 cases, Stage II in 5 cases, Stage III in 0 cases) and splenic vein occlusion in all 18 patients. Three-dimensional reconstruction of the portal vein by computed tomography found neither dilatation nor thrombosis of the portal vein, but had splenic vein occlusion and gastric varices in all 18 cases [Figure 1]. Gastroscope or upper gastrointestinal radiography found gastric varices in all 18 cases, and esophageal varices in 4 cases.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

However, these symptoms are nonspecific, which as a consequence leads to late diagnosis as well as a low resection rate between 10% and 30%, with a 5 years overall survival rate below 10%... That how to increase early diagnosis of the pancreatic body and tail carcinoma has been a difficult problem since then... As a kind of extrahepatic portal hypertension, the main manifestations of PSPH are splenomegaly and gastrosplenic varices, without abnormalities in liver function and portal vein... PSPH is rare and curable, found in about 5–10% of the extrahepatic portal hypertension cases... The Doppler ultrasound showed splenomegaly (Stage I in 13 cases, Stage II in 5 cases, Stage III in 0 cases) and splenic vein occlusion in all 18 patients... Three-dimensional reconstruction of the portal vein by computed tomography found neither dilatation nor thrombosis of the portal vein, but had splenic vein occlusion and gastric varices in all 18 cases [Figure 1]... We found that the pancreatic body and tail carcinomas were all located within the pancreatic capsule and no sign of metastasis, normal liver, splenomegaly, and short gastric vein, gastroepiploic vein, gastric coronary vein dilated in gastrosplenic region... Surgeries in all patients were successful, and there were no mortalities... The patients were followed-up for a duration range 12–60 months, and only one nonoperative patient lost of follow-up (follow-up rate 94.4%)... All operative patients found no upper digestive tract hemorrhage and disappearance of hypersplenism after surgery... Thus, early diagnosis and therapy is of great significance to improve the prognosis of pancreatic body and tail carcinoma... The resection rate in our study was 55.5%, which was higher than other reports, indicating that early diagnosis and treatment are possible for the patients with pancreatic body and tail carcinoma manifesting gastroesophageal varices bleeding and splenomegaly... Nevertheless, the gastroesophageal varices bleeding more urgent and may cause death when bleeding happens... We conclude that the prevention and treatment of upper digestive tract bleeding in PSPH are more important in these cases... Therefore, we should aim to achieve early diagnosis and treatment as far as possible of pancreatic body and tail carcinoma patients through clinical manifestations of gastroesophageal varices (bleeding) as well as splenomegaly.

Show MeSH
Related in: MedlinePlus