European Journal of Biomedical and Pharmaceutical Sciences

OUR EXPERIENCE WITH ETIOLOGY AND MANAGEMENT OF SINISTRAL PORTAL HYPERTENSION

Sadaf Ali Bangri, Faroze A. Khan*, Mehmooda Akhtar, Khalid Basheer, Muneer Ahmad Bhat, Sudarshan Reddy

ABSTRACT

Objective: Sinistral portal hypertension (SPH), is a rare clinical syndrome of gastric variceal hemorrhage due to splenic vein thrombosis. This retrospective study highlights the varied etiology, clinical features and outcome of surgical treatment. Subject and Method: From June 2010 to June 2015 medical records of patients diagnosed as SPH were analysed. Their clinical features, investigations, surgical intervention and follow up were studied. Results: 12 patients,5 males and 7 females were included into the study. Etiology of SPH was chronic pancreatitis (CP) in 5 patients, hydatid spleen in 4 patients, mucinous cyst of tail of pancreas in 2 patients and post surgical splenic vein thrombosis in 1 patient. All the patients were operated with splenectomy and devascularisation done in 5, splenectomy with lateral pancreaticojejunostomy (LPJ) with devascularization in 2 cases while splenectomy with distal pancreatectomy and devascularisation done in 4 and distal pancreatectomy with ligation of splenic artery done in 1 patient. After a mean follow up of 38.5 months there was no episode of bleed in any patient. Conclusions: SPH has varied etiology and should be suspected in patients with upper gastrointestinal bleed along with spleenomegaly and normal liver functions. In symptomatic cases splenectomy alongwith devascularization provides excellent outcome.

Keywords: Sinistral portal hypertension, Spleenomegaly, Gastric varices.