Laparoscopic Treatment of Presinusoidal Schistosomal Portal Hypertension Associated With Postoperative Endoscopic Treatment: Results of a New Approach

Colaneri, Renata Potonyacz; Coelho, Fabrício Ferreira; Cleva, Roberto de; Herman, Paulo

doi:10.1097/sle.0000000000000302

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…To reduce venous blood reflux, splenectomy remains the preferred treatment for patients with gastric bleeding due to LSPH, and splenic artery embolization can be used as a supplementary measure in patients in whom splenectomy is deemed unsuitable [ 13 , 16 , 17 , 19 , 57 – 59 ]. Moreover, while endoscopic therapy is highly advantageous for the treatment of acute massive gastric bleeding, rebleeding is unavoidable [ 60 – 63 ]. We are also currently investigating whether LSPH due to mechanical compression can be corrected via stent implantation.…”

Section: Discussionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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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.

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Section: Discussionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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“…This pilot study derived from their observation that during EGDS, the most important surgical moment, from the hemodynamical point of view, was the ligature of the splenic artery. Within the 7 years follow-up of the 10 included patients, good outcomes were reported, with only 1 patient developing spleen infarction, which resolved with conservative therapy [72,73].…”

Section: "Classic" Surgical Interventionsmentioning

confidence: 95%

“…intervention seems overall comparable with that following EGDS, and the Authors commented on the lower surgical complexity and risk of this variant procedure compared to the classic EGDS [71]. Among variant interventions, Colaneri and colleagues [72,73], aiming to preserve the spleen while performing vascular disconnection, applied a technique envisaging ligation of the splenic artery, ligation of the gastric vein, and variceal banding if required at endoscopic evaluation 30 days postintervention. This pilot study derived from their observation that during EGDS, the most important surgical moment, from the hemodynamical point of view, was the ligature of the splenic artery.…”

Section: "Classic" Surgical Interventionsmentioning

confidence: 99%

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Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

et al. 2021

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Background Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. Methodology/principal findings We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. Conclusions Most interventions have been developed on the basis of individual groups’ experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

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“…Na tentativa de encontrar um tratamento cirúrgico que promova a redução na pressão portal com um mínimo de alterações fisiológicas e capaz de reverter as consequências do hiperesplenismo (Ferraz et al, 2011), alguns autores têm apresentado bons resultados em estudos que avaliaram tratamentos cirúrgicos menos complexos que a DAPE no controle das varizes esofageanas. Exemplos são a esplenectomia e ligadura da veia gástrica esquerda (Evangelista Neto et al, 2012;Batista Neto et al, 2013), ligadura da artéria esplênica e veia gástrica esquerda associadas ao tratamento endoscópico pelas vias convencional ou laparoscópica (Colaneri et al, 2014;Colaneri et al, 2017). Ou até esplenectomia, ligadura da veia gástrica esquerda e desvascularização da grande curvatura (Ferraz et al, 2000).…”

Section: Trombose Portal Pós-operatóriaunclassified

Queda da pressão portal após desconexão ázigo-portal e esplenectomia em pacientes esquistossomóticos: impacto no comportamento das varizes esofageanas, na taxa de ressangramento e na trombose de veia porta

Neto¹,

da²

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Laparoscopic Treatment of Presinusoidal Schistosomal Portal Hypertension Associated With Postoperative Endoscopic Treatment: Results of a New Approach

Abstract: Laparoscopic ligature of the splenic artery and the left gastric vein is a promising and less-invasive method for the treatment of schistosomal portal hypertension.

Cited by 3 publications

References 25 publications

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

Queda da pressão portal após desconexão ázigo-portal e esplenectomia em pacientes esquistossomóticos: impacto no comportamento das varizes esofageanas, na taxa de ressangramento e na trombose de veia porta

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