Background: Left-sided portal hypertension (LSPH) is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression. Specific symptoms are often lacking, rendering it difficult to diagnose. Splenectomy is the main treatment for cases complicated by variceal bleeding, and the effects of treatment primarily depend on the condition of the primary disease. Case presentation: The patient was a 29-year-old woman who was admitted to the hospital for repeated hematemesis and black stool. She had been misdiagnosed with pancreatic cancer 7 years prior. Combined imaging and endoscopic examination indicated varicose gastric fundus veins, a pancreatic mass, and enlarged peripancreatic lymph nodes. Laboratory investigations revealed reduced erythrocyte, platelet, and leukocyte counts, the interferon gamma release assay was positive, and liver function was normal. Abdominal exploration, splenectomy, varicose vein dissection, and lesion resection were performed via laparotomy. Postoperative biopsy analysis confirmed the diagnosis of lymph node tuberculosis. Based on the above-described factors, LSPH caused by peripancreatic lymph node tuberculosis was a diagnosed. Conclusions: Herein we describe the first reported case of LSPH caused by peripancreatic lymph node tuberculosis. When left portal hypertension occurs simultaneously, peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies are necessary to develop a more favorable diagnostic method for pancreas masses and more advantageous therapy for LSPH, especially in cases caused by mechanical compression.
Background: As the only curable portal hypertension, left-sided portal hypertension (LSPH) is a very rare clinical syndrome. With normal liver function, LSPH is mostly due to pancreatic disease and its complications that cause spleen vein compression, inflammatory wall thickening or lumen blockage, isolated splenic vein thrombosis, restricted splenic vein reflux, finally resulting in increased splenic vein pressure, opened collateral circulation, and bleeding from isolated gastric varices. With a quiet occurrence, LSPH often lacks specific symptoms, which finally leads to difficult diagnosis. Therefore, acuminous options of clinical examination are exceedingly crucial. Splenectomy is the prime treatment for cases complicated by variceal bleeding, but the effect of treatment depends mainly on the condition of the primary disease. Other than these, diseases resulting in LSPH often need to be distinguished from pancreatic cancer, so it is necessary for us to pay more attention to the diagnosis and treatment of LSPH. Case presentation: Here, we report a case of 29-year-old women who was admitted to the hospital for repeated hematemesis and black stool, with a differential diagnosis of pancreatic cancer seven years ago. Abdominal computed tomography (CT), CT angiography (CTA), portal phase three-dimensional vascular reconstruction, and gastroscopy indicated varicose gastric fundus veins, pancreatic mass, and enlarged peripancreatic lymph nodes. Erythrocyte, platelet, and leukocyte counts in decline, positive gamma interferon release assay, and normal liver function were given by laboratory examination. Abdominal exploration, splenectomy, varicose veins dissection, and lesions resection were performed by laparotomy. After surgery, the diagnosis of lymph node tuberculosis was confirmed by the technology of biopsy. Based on mention above, a diagnosis of LSPH caused by peripancreatic lymph node tuberculosis was confirmed. Postoperative evolution was steady, and the patient was in ideal clinical status at 3 months follow-up. Conclusions: We reported the first case of LSHP caused by peripancreatic lymph node tuberculosis. At the same time of resulting in left portal hypertension, the peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies were necessary to explore more favorable diagnosis method for pancreas mass and more advantageous therapy for LSPH, especially caused by mechanical compression.
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