Gastric Varices Secondary to Splenic Vein Occlusion: Radiographic Diagnosis and Clinical Significance

Muhletaler, Carlos A.; Gerlock, Amil J.; Goncharenko, Victor; Avant, George R.; Flexner, John M.

doi:10.1148/132.3.593

Cited by 56 publications

(24 citation statements)

References 6 publications

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“…Splenic vein occlusion is characterized by gastric varices, splenomegaly, and normal liver function, and results in left-sided portal hypertension, [9][10][11] which is secondary to pancreatic inflammation or neoplasm. 12,13 The tail of the pancreas is enveloped with splenic vessels and the splenorenal ligament at the hilus of the spleen, and this anatomical proximity results in intimal damage of the splenic vein.…”

Section: Discussionmentioning

confidence: 99%

Gastric varices with splenic vein occlusion treated by splenic arterial embolization

Sato

Yamazaki

Toyota

et al. 2000

Journal of Gastroenterology

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A 53-year-old man was admitted to our hospital in August 1997 with enlarged gastric varices. Computed tomography (CT) showed splenic vein occlusion, gastric varices, and extra-gastric wall collateral veins. Color flow images of gastric varices were clearly visualized, and the velocity in the gastric varices was 19.6 cm/s via endoscopic color Doppler ultrasonography (ECDUS). The patient was diagnosed with gastric varices according to angiographic findings of splenic vein occlusion, and splenic arterial embolization was performed. Two weeks after the splenic arterial embolization, CT showed peripheral areas of low attenuation in the spleen, due to splenic infarction, with 70% of the spleen volume showing low attenuation. Eight months after the splenic arterial embolization, ECDUS revealed a decrease in gastric variceal color flow images, with the velocity in the gastric varices being 10.3 cm/s.

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Section: Discussionmentioning

confidence: 99%

Gastric varices with splenic vein occlusion treated by splenic arterial embolization

Sato

Yamazaki

Toyota

et al. 2000

Journal of Gastroenterology

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“…On double-contrast radiographs, the varices usually appear as thickened tortuous folds in the gastric fundus. Less frequently, a conglomerate of varices produces a single lobulated filling defect [13]. These appearances are however nonspecific and can result from other conditions, such as a carcinoma, lymphoma, multiple polyps, or Menetrier's disease [13].…”

Section: Discussionmentioning

confidence: 99%

Isolated gastric varices: Ultrasound detection

Malde¹,

Kedar²,

Chadha³

1993

Abdom Imaging

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Abstract. Isolated gastric varices (IGV) (resulting from varying etiologies) were diagnosed in six patients using ultrasound examination of the wall of the fluid-filled stomach. Small gastric varices are seen as circular or linear anechoic channels within the gastric wall without a significant intraluminal projection. Large varices are seen as anechoic, lobulated "bulging masses" projecting into the fluid-filled lumen of the stomach. Doppler technique assists in confirming the vascular nature of these lesions and thus avoids confusion with other hypoanechoic lesions of the gastric wall. The technique is simple, noninvasive, and extremely useful in diagnosing IGV in patients investigated for recurrent undiagnosed gastrointestinal bleeding.Key words: Isolated gastric varices, US--Doppler techniques.The detection of isolated gastric varices (IGV) remains a diagnostic challenge. The accuracy of barium studies for detecting IGV ranges from 14-74% [1, 2] depending upon the radiologic criteria used to make the diagnosis. The reliability of endoscopy in diagnosing gastric varices, though poorly documented, is far from satisfactory [3]. Until recently splenoportovenography (SPVG) has been the investigation of choice for detecting isolated gastric varices, as well as for demonstrating its etiology. However, it is slowly being replaced by less invasive procedures, such as arterioportography [4]. Although IGV have been detected on computed tomography (CT) [5], its high cost, poor accuracy, and the use of ionizing radiation make it unsuitable for screening patients suspected of having isolated gastric varices. We describe a new technique employing the fluidfilled stomach as a window to detect IGV aided by flow detection through the Doppler technique. Materials and MethodsBetween October 1990 and June 1991, IGV were diagnosed in six patients (four males and two females) at our institution. These patients ranged from 12-58 years in age. Four of the six patients were investigated for recurrent undiagnosed gastrointestinal bleeding, whereas the other two had splenomegaly. Causes for the IGV in these patients included portal vein thrombosis (two patients), splenic vein thrombosis (two patients), noncirrhotic portal fibrosis (one patient), and liver cirrhosis (one patient).Real-time sonography was performed in all patients using a variety of convex and sector transducers ranging in frequency from 3.5-7.5 MHz (Sonoline AC, Siemens Inc. Ltd). In all patients, duplex Doppler sonography was performed using the same equipment. Detection of these variceal channels within the gastric wall was facilitated by employing the technique advocated by others to assist detection of gastric wall [7] and pancreatic head lesions [8] using the fluid-filled stomach as a sonographic window.Apart from abdominal sonography, endoscopic examination of the esophagus and stomach was performed in all patients. The presence of the IGV detected on abdominal sonography was confirmed by a SPVG in all patients.After a routine upper abdominal sonography, the fasting...

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“…Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition [9,11,13,41,42]. Due to the absence of malignant diseases in our patients, splenectomy was a useful treatment for left-sided portal hypertension.…”

Section: Treatments Of Gastric Varices Secondary To Left-sided Portalmentioning

confidence: 93%

“…Splenic vein occlusion results in left-sided portal hypertension (characterized by gastric varices, splenomegaly and normal liver function) [9][10][11] that is secondary to various diseases [12][13][14]. The majority of splenic vein occlusions are the result of pancreatic diseases, including acute and chronic pancreatitis or pancreatic tumor.…”

Section: Pathophysiology/symptoms Of Left-sided Portal Hypertensionmentioning

confidence: 99%

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Kimura¹

2013

Pancreat Disord Ther

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Sato et al., Pancreatic Dis Ther 2013, S3 http://dx.doi.org/10.4172/2165 Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases Takahiro Sato*, Sho Kitagawa, Mutsuumi Kimura, Takumi Ohmura, Yoshiyasu Karino and Jouji Toyota Department of Gastroenterology, Sapporo Kosei General Hospital, Japan occlusion because of the splenic vein, s anatomy. Sutton et al. reported that 35% of their cases of isolated splenic vein occlusion were caused by tumors and only 17% by pancreatitis [9]. On the other hand, Sakorafas et al. found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]. There is a possible pathogenetic mechanism implying the increased intra-abdominal pressure leading to compression of the splenic vein in the case of pancreatic pseudocyst [19,20].Due to splenic vein occlusion, splenic venous flow must drain into collateral veins (short gastric vein and left gastroepiploic vein). Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.Although splenic vein occlusion is commonly silent clinically, AbstractGastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches.Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body.Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the sp...

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Gastric Varices Secondary to Splenic Vein Occlusion: Radiographic Diagnosis and Clinical Significance

Cited by 56 publications

References 6 publications

Gastric varices with splenic vein occlusion treated by splenic arterial embolization

Gastric varices with splenic vein occlusion treated by splenic arterial embolization

Isolated gastric varices: Ultrasound detection

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

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