Segmental portal hypertension secondary to chronic pancreatitis

Introduction and objectives

Case presentation of a male patient with portal hypertension secondary to chronic pancreatitis

Materials and Patients

This is a 38-year-old male patient, occasional drinker, risky consumption, history of diagnosis of diabetes mellitus, with adequate adherence to hypoglycemic treatment with metformin, presented a clinical picture of 3 years of evolution consisting of severe pain in the upper abdomen with irradiation to the back on the left side, which required emergency admissions with stabilization and discharge with subsequent recurrence, as well as significant weight loss of 10% over a period of 8 months. He was admitted to the emergency department with clinical symptoms compatible with upper gastrointestinal bleeding due to the presence of melaenic bowel movements on multiple occasions, associated with anemic syndrome, biochemically highlighting a Hb of 2.4 mg/dl, with normal liver function tests and other laboratories, with no changes of chronic hepatopathy by ultrasound.

Results

Regarding the approach to the digestive tract bleeding, Panendoscopy was performed, showing mucosa without alterations, without observing bleeding during the study, ruling out the presence of varices at esophageal level, proceeding to the realization of contrasted Angio Tomography, where findings of segmental portal hypertension with spleno-portal collateral vessels, splenic thrombosis and pancreatic calcifications suggestive of changes due to chronic pancreatitis were observed, with an area of enhancement at the level of the gastric fundus at the site of gastric varices, splenomegaly was not reported. For treatment selection, interventional radiology was evaluated, offering as a therapeutic option the recanalization of the splenic vein with stent placement; however, since Splenectomy was still considered as the definitive treatment for segmental portal hypertension, the latter intervention was chosen for resolution, with adequate evolution after the procedure, remission of bleeding and corroborating adequate flow redistribution after surgery by means of new Angio-CT. The patient attends his consultations on a regular basis, with good evolution, good glycemic control and improvement in nutritional status.

Conclusions

Segmental portal hypertension (SPH) is due to the presence of isolated obstruction of the splenic vein by thrombosis or extrinsic compression.

Pancreatitis conditions the development of thrombosis because the inflammatory state induces stasis and damage of the intima related to the contact of the splenic vein and the pancreas.

The presence of isolated gastric varices makes it necessary to rule out splenic venous thrombosis.

The definitive treatment continues to be splenectomy, reducing the flow to the varices and collateral circulation.

Ethical statement

The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.