Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Abstract

Sinistral portal hypertension (SPH), also known as left-sided portal hypertension or segmental portal hypertension, is a rare cause of upper gastrointestinal bleeding. Historically, SPH is a result of obstruction of the splenic vein often secondary to pancreatic pathology. To our knowledge, there are no reported cases of idiopathic SPH in which the findings cannot be attributed to any etiology. It is important to do a detailed workup to rule out common pathologies of SPH before making a diagnosis of idiopathic SPH. Treatment of gastric variceal bleed secondary to idiopathic SPH can be challenging and requires a multidisciplinary approach with surgery and interventional radiology. Our patient's history, examination findings, and imaging revealed no identifiable cause for SPH suggesting idiopathic SPH. We describe a case of isolated gastric variceal hemorrhage due to idiopathic SPH that was successfully treated.

Sinistral Portal Hypertension Due to a Pancreatic Pseudocyst: A Rare Cause of Upper Gastrointestinal Bleeding

“…SPH is an extremely rare clinical entity characterized by elevated splenoportal pressure due to SVT 7 , 8 or obstruction. 9 Unlike conventional portal hypertension, SPH presents with a patent-extrahepatic portal vein 6 , 10 and normal liver function.…”

“… 6 , 11 , 12 Splenoportal hypertension is commonly associated with pancreatic disorders such as acute pancreatitis, chronic pancreatitis, PPs, pancreatic neoplasms, and pancreatic surgery. 7 , 8 , 10 , 11 …”

Varicose vein embolization and portal vein stenting in a patient with sinistral portal hypertension-induced gastrointestinal hemorrhage: a case report

“…For instance, some studies have reported that sinistral portal hypertension could induce pancreatic adenocarcinoma 14 , 15 . Another study discloses that sinistral portal hypertension could lead to gastric variceal hemorrhage 16 . Therefore, the timely management of sinistral portal hypertension is important 17 , 18 .…”

Two Cases of Gastric Varices with Left-sided Portal Hypertension Due to Essential Thrombocythemia Treated with Gastric Devascularization or Partial Splenic Embolization

“…LSPH patients suffer from gastric varices (GVs) associated with abnormal dilatation of the gastric venous system to return excess splenic blood to the liver, leading to massive bleeding and mortality (4,5). Although balloonoccluded retrograde transvenous obliteration (BRTO) or endoscopic injection sclerotherapy (EIS) are often performed for GVs associated with cirrhotic portal hypertension, BRTO or EIS are not suitable for GVs associated with LSPH be-cause of their vascular anatomy and hemodynamics (1,5).…”