Splenomegaly and left sided portal hypertension

Abstract

Background: Left-sided portal hypertension (L.S.P.H.) is
usually associated with splenic vein occlusion or arteriovenous
fistulae of splenic vessels ; however there have been
some case reports of L.S.P.H. in patients with splenomegaly,
without vein occlusion or fistulae.
In the present study we include a number of patients with
haematological diseases and an enlarged spleen without
thrombosis in order to study the circulation of the splenic
area.
Patients and methods: During a two and a half year period
53 patients with haematological diseases and splenic enlargement
were investigated by esophagogastroscopy and
ultrasonography (US) of the splenic area focused on the
perisplenic circulation.
Results: Thirty four out of 53 patients of the study, underwent
both endoscopy and US investigations, 9 underwent
endoscopy only and 10 underwent only US examination.
Fourteen out of 34 patients (i.e. 43%) had endoscopic findings
of varices or congestive gastropathy and 15 out of 34
(i.e. 44%) had abnormal circulation around the spleen in
the ultrasound examination. Among the 19 patients who
underwent either endoscopy or ultrasonography only there
were 8 patients with positive findings (4 in the endoscopy
group and 4 in the US group).
A possible explanation may be that the spleen receives
through its enlarged splenic artery an increased volume of
blood, which leads to an enlargement of the splenic vein.
The vein remains open but cannot accommodate this increased
blood volume; this causes impaired venous drainage
and finally the blood drains through the short gastric
veins or retroperitoneal collaterals.
Conclusions: We concluded from our study that patients
with splenomegaly due to haematological disorders carry a
high risk to develop left sided portal hypertension.
Key words: Left Sided Portal Hypertension, Portal Hypertension,
Sinistral Portal Hypertension, Splenomegaly,
Variceal bleeding, Esophagogastric varices