Skip to main content

Advertisement

SpringerLink
Log in

Left-Sided Portal Hypertension

  • Review Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Left-sided portal hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. Pancreatic disease is the most common etiology. Left-sided portal hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. It may be difficult to diagnose this entity both endoscopically and radiologically. While splenectomy is the treatment of choice for cases complicated by variceal bleeding, there is no consensus on the treatment of asymptomatic patients. The prognosis of left-sided portal hypertension mainly depends on the underlying etiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Glynn MJ (1986) Isolated splenic vein thrombosis. Arch Surg 121:723–725

    PubMed  CAS  Google Scholar 

  2. Weber SM, Rikkers LF (2003) Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J Surg 27:1271–1274

    Article  PubMed  Google Scholar 

  3. Madsen MS, Petersen TH, Sommer H (1986) Segmental portal hypertension. Ann Surg 204:72–77

    Article  PubMed  CAS  Google Scholar 

  4. Sutton JP, Yarborough DY, Richard JT (1970) Isolated splenic vein occlusion. Review of literature and report of an additional case. Arch Surg 100:623–626

    CAS  Google Scholar 

  5. Evans GRD, Yellin AE, Weaver FA, et al. (1990) Sinistral (left-sided) portal hypertension. Am Surg 56:758–763

    PubMed  CAS  Google Scholar 

  6. Adams DB, Mauterer DJ, Vujic IJ, et al. (1990) Preoperative control of splenic artery inflow in patients with splenic venous occlusion. South Med J 83:1021–1024

    PubMed  CAS  Google Scholar 

  7. Sakorafas GH, Sarr MG, Farley DR, et al. (2000) The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg 179:129–133

    Article  PubMed  CAS  Google Scholar 

  8. Little AG, Moossa AR (1981) Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis. Am J Surg 141:153–158

    CAS  Google Scholar 

  9. Hwang TL, Jan YY, Jeng LB, et al. (1999) The different manifestation and outcome between pancreatitis and pancreatic malignancy with left-sided portal hypertension. Int Surg 84:209–212

    PubMed  CAS  Google Scholar 

  10. Bernades P, Baetz A, Levy P, et al. (1992) Splenic and portal venous obstruction in chronic pancreatitis: A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci 37:340–346

    Article  PubMed  CAS  Google Scholar 

  11. Leger L, Lenriot JP, Lemigre G (1968) L’hypertension et la stase portales sgmentaires dans les pncreatites chronique: A propos de 126 cas examines par spleno-portographie et spleno-manometrie. J Chir (Paris) 95:599–608

    CAS  Google Scholar 

  12. Lavender S, Lloyd-Davis RW, Thomas ML (1970) Retroperitoneal fibrosis causing localized portal hypertension. Br Med J 3:627–628

    Article  PubMed  CAS  Google Scholar 

  13. Salam AA, Warren WD, Tyras DH (1973) Splenic vein thrombosis: A diagnosable and curable form of portal hypertension. Surgery 74:961–972

    PubMed  CAS  Google Scholar 

  14. Rösch W (1974) Isolated gastric varices: a hint of pancreatic disorders. Endoscopy 6:217–220

    Article  Google Scholar 

  15. Itzchak Y, Glickmann MG (1977) Splenic vein thrombosis in patients with a normal size spleen. Invest Radiol 12:158–163

    Article  PubMed  CAS  Google Scholar 

  16. Moossa AR, Gadd MA (1985) Isolated splenic vein thrombosis. World J Surg 9:384–390

    Article  PubMed  CAS  Google Scholar 

  17. Köklü S, Köksal A, Bayram G, et al. (2004) Isolated splenic vein thrombosis: An unusual cause and review of the literature. Can J Gastroenterol 19:837–838

    Google Scholar 

  18. Salam AA, Warren WD (1974) Anatomic basis of the surgical treatment of portal hypertension. Surg Clin North Am 54:1247–1257

    PubMed  CAS  Google Scholar 

  19. Brooks DH (1975) Surgery of the spleen. Surg Clin North Am 55:287–301

    PubMed  CAS  Google Scholar 

  20. Warshaw AL, McChesney T, Evans GW, et al. (1972) Intrasplenic dissection by pancreatic pseudocysts. N Engl J Med 287:72–75

    Article  PubMed  CAS  Google Scholar 

  21. Nogueira Soriano JM, Diez GF, Pelaez DG, et al. (1991) Segmental portal hypertension due to a retroperitoneal abscess of tuberculous etiology. Rev Esp Enferm Dig 79:211–213

    PubMed  CAS  Google Scholar 

  22. Köklü S, Yüksel O, Arhan M, et al. (2005) Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study. Dig Dis Sci 50:976–982

    Article  PubMed  Google Scholar 

  23. Heider TR, Azeem S, Galanko JA, et al. (2004) The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg 239:876–882

    Article  PubMed  Google Scholar 

  24. Manenti A (1981) Splenic vein obstruction secondary to pancreatic carcinoma. Acta Chir Belg 80:245–248

    PubMed  CAS  Google Scholar 

  25. Keith RG, Mustard RA Jr, Saibil EA (1982) Gastric variceal bleeding due to occlusion of splenic vein in pancreatic disease. Can J Surg 25:301–304

    PubMed  CAS  Google Scholar 

  26. Illig KA, Spitzer RM, Oates TK (1997) Optimal diagnosis of splenic vein thrombosis. Am Surg 63:1005–1006

    PubMed  CAS  Google Scholar 

  27. Lankısch PG (1990) The spleen in inflammatory pancreatic disease. Gastroenterology 98:509–516

    PubMed  Google Scholar 

  28. Longstreth GF, Newcomer AD, Green PA (1971) Extrahepatic portal hypertension caused by chronic pancreatitis. Ann Intern Med 75:903–908

    PubMed  CAS  Google Scholar 

  29. McElroy R, Christiansen PA (1972) Hereditary pancreatitis in a kinship associated with portal vein thrombosis. Am J Med 52:228–241

    Article  PubMed  CAS  Google Scholar 

  30. Wolf JH, Long RJ, Miller FJ, et al. (1977) Pancreatic islet cell tumour presenting as bleeding gastric varices secondary to splenic vein occlusion. Am J Dig Dis 22:652–655

    Article  PubMed  CAS  Google Scholar 

  31. Gallardo-Navarra V, Phillips E, Neyfeld P, et al. (1973) Segmental portal hypertension and islet cell adenoma of the pancreas. JAMA 226:1466

    Article  PubMed  CAS  Google Scholar 

  32. Bok EJ, Cho KJ, Williams DM, et al. (1984) Venous involvement in islet cell tumours of the pancreas. Am J Roentgenol 142:319–322

    CAS  Google Scholar 

  33. Sheers R (1980) A pancreatic cystadenoma complicated by varices: Case report. Br J Surg 67:144–145

    Article  PubMed  CAS  Google Scholar 

  34. Rogers C, Klatt EC (1989) Splenic vein thrombosis in patients with acute pancreatitis. Int J Pancreatol 5:117–121

    PubMed  CAS  Google Scholar 

  35. Negus D, Cotton P (1973) Splenic vein thrombosis with pancreatic pseudocyst. Proc Roy Soc Med 66:649–650

    PubMed  CAS  Google Scholar 

  36. Wolloch Y, Chaimoff C, Lubin E, et al. (1974) Splenic vein thrombosis, segmental portal hypertension and bleeding esophageal varices produced by a congenital pancreatic cyst. Israel J Med Sci 10:670–673

    PubMed  CAS  Google Scholar 

  37. Harnar T, Johansen K, Haskey R, et al. (1982) Left-sided portal hypertension from pancreatic pseudotumor. Am J Gastroenterol 77:639–641

    PubMed  CAS  Google Scholar 

  38. Vos LJM, Potocky V, Broker FHL, et al. (1974) Splenic vein thrombosis with oesophageal varices: A late complication of umbilical vein catheterization. Ann Surg 180:152–156

    Article  PubMed  CAS  Google Scholar 

  39. Honda Y, Ueda M, Kyoi M, et al. (1978) An unusual case of portosystemic encephalopathy caused by splenic vein occlusion following gastrectomy. Am J Gastroenterol 69:590–593

    PubMed  CAS  Google Scholar 

  40. Koehler RE (1981) Splenic vein obstruction due to metastatic hypernephroma. Gastrointest Radiol 6:365–370

    Article  PubMed  CAS  Google Scholar 

  41. Shaldon S, Sherlock S (1962) Portal hypertension in the myeloproliferative syndrome and the reticuloses. Am J Med 32:758–764

    Article  PubMed  CAS  Google Scholar 

  42. Takeuchi H, Suzuki M, Unno M, et al. (2000) Splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum. Surg Today 30:383–385

    Article  PubMed  CAS  Google Scholar 

  43. Alam H, Kim D, Provido H, et al. (1997) Portal venous thrombosis in the adult. Surgical implications in an era of dynamic imaging. Am Surg 63:681–684

    CAS  Google Scholar 

  44. Bradley EL (1987) The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery. Int J Pancreatol 2:87–92

    PubMed  Google Scholar 

  45. Warshaw AL, Jin GL, Ottinger LW (1987) Recognition and clinical implication of mesenteric and portal vein obstruction in chrnic pancreatitis. Arch Surg 122:410–415

    PubMed  CAS  Google Scholar 

  46. Blendis LM, Banks DC, Ramboer C, et al. (1970) Spleen blood flow and splanchnic haemodynamics in blood dyscrasia and other splenomegalies. Clin Sci 38(1):73–84

    PubMed  CAS  Google Scholar 

  47. Witte CL, Chung YC, Witte MH, et al. (1969) Observations on the origin of ascites from experimental extrahepatic portal congestion. Ann Surg 170:1002–1015

    Article  PubMed  CAS  Google Scholar 

  48. Marshall JP, Smith PD, Hoyumpa AM (1977) Gastric varices: problem in diagnosis. Am J Dig Dis 22:947–955

    Article  PubMed  Google Scholar 

  49. Muhtehaler C, Gerlock AJ, Goncharenko V, et al. (1979) Gastric varices secondary to splenic vein occlusion: radiographic diagnosis and clinical significance. Radiology 132:593–598

    Google Scholar 

  50. Rice RP, Thompson WM, Keloin FM, et al. (1977) Gastric varices without esophageal varices: an important pre-endoscopic diagnosis. JAMA 237:1976–1979

    Article  PubMed  CAS  Google Scholar 

  51. Korr S, Wohl GT (1960) Clinical importance of gastric varices. N Engl J Med 263:665–669

    Article  Google Scholar 

  52. Gabrielson N (1971) Diagnosis of gastric varices by conventional roentgenography as compared with splenoportal phlebography. Acta Radiol Diagn 11:506–514

    Google Scholar 

  53. Cho KJ, Martel W (1978) Recognition of splenic vein occlusion. Am J Roentgenol 131:439–443

    CAS  Google Scholar 

  54. Okuda K, Yasumoto M, Goto A, et al. (1973) Endoscopic observations of gastric varices. Am J Gastroenterol 60:357–365

    PubMed  CAS  Google Scholar 

  55. Mathur SK, Dalvi An, Someshwar V, et al. (1990) Endoscopic and radiological appraisal af gastric varices. Br J Surg 77:432– 435

    Article  PubMed  CAS  Google Scholar 

  56. Yale CE, Crummy AB (1971) Splenic vein thrombosis and bleeding esophageal varices. JAMA 217:317–320

    Article  PubMed  CAS  Google Scholar 

  57. Gattoni F, Baldini U, Pozzato C, et al. (1990) Pure and diluted contrast media in the visualization of the portal venous system using digital angiography. Radiol Med (Torino) 80:321–324

    CAS  Google Scholar 

  58. Johansen K, Paun M (1990) ltrasonography of the portal vein. Surg Clin North Am 70:181–190

    PubMed  CAS  Google Scholar 

  59. Alpern MD, Rubin JM, Williams DM (1987) Porta hepatis: duplex Doppler US with angiographic correlation. Radiology 162:53–56

    PubMed  CAS  Google Scholar 

  60. Finn JP, Kane RA, Edelman LJ, et al. (1993) Imaging of the portal venous system in patients with cirrhosis: MR angiography vs. duplex Doppler sonography. Am J Roentgenol 161:989–994

    CAS  Google Scholar 

  61. Naik KS, Ward J, Irving HC, et al. (1997) Comparison of dynamic contrast-enhanced MRI and Doppler ultrasound in the pre-operative assessment of the portal venous system. Br J Radiol 70:43–49

    PubMed  CAS  Google Scholar 

  62. Capasso P, Dondelinger RF (1998) Vascular disorders of the liver. In: Gazelle GS, Saini S, Mueller PR (eds) Hepatobiliary and pancreatic radiology: imaging and intervention. 1st ed. Thieme, New York, pp 294–334

    Google Scholar 

  63. Wiersema MJ, Kochman ML, Cramer HM, et al. (1994) Endosonography-guided real-time fine needle aspiration biopsy. Gastrointest Endosc 40:700–707

    PubMed  CAS  Google Scholar 

  64. Lewis JD, Faigel DO, Morris JB, et al. (1998) Splenic vein thrombosis secondary to focal pancreatitis diagnosed by endoscopic sonography. J Clin Gastroenterol 26:54–56

    Article  PubMed  CAS  Google Scholar 

  65. Rosch T (1994) Endoscopic ultrasonography in pancreatic cancer. Endoscopy 26:806–807

    Article  PubMed  CAS  Google Scholar 

  66. Wiersema MJ, Hawes RH, Lehman GA, et al. (1993) Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 25:555– 564

    Article  PubMed  CAS  Google Scholar 

  67. Lo GH, Lai KH,Wang SJ, et al. (1997) Comparison of endoscopic ultrasound and computed tomogram in the evaluation of periesophageal varices. J Ultrasound Med 5:83–88

    Google Scholar 

  68. Caletti GC, Brocchi E, Baraldini M, et al. (1990) Assessment of portal hypertension by endoscopic ultrasonography. Gastrointest Endosc 36:21–27

    Article  Google Scholar 

  69. Caletti GC, Brocchi E, Ferrari A, et al. (1992) Value of endoscopic ultrasonography in the management of portal hypertension. Endoscopy 24:342–346

    Article  PubMed  Google Scholar 

  70. Lo GH, Lai KH, Cheng JS, et al. (1999) Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc 49:428–436

    Article  PubMed  CAS  Google Scholar 

  71. Boustiere C, Dumas O, Jouffre C, et al. (1993) Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings. J Hepatol 19:268–272

    CAS  Google Scholar 

  72. Gollin G, Ward B, Meier GH, et al. (1994) Central splanchnic venous thrombosis: often unsuspected, usually uncomplicated. J Clin Gastroenterol 18:109–113

    Article  PubMed  CAS  Google Scholar 

  73. Vogelzang RL, Gore RM, Anschuetz SL, et al. (1988) Thrombosis of the splanchnic veins: CT diagnosis. AJR Am J Roentgenol 150:93–96

    PubMed  CAS  Google Scholar 

  74. Rahmouni A, Mathieu D, Mondher G, et al. (1992) Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 17:135–140

    Article  PubMed  CAS  Google Scholar 

  75. Mori H, McGrath FP, Malone DE, et al. (1992) The gastrocolic trunk and its tributaries: CT evaluation. Radiology 182:871–877

    PubMed  CAS  Google Scholar 

  76. Finn JP, Edelman RR, Jenkins RL, et al. (1991) Liver transplantation: MR angiography with surgical validation. Radiology 179:265–269

    PubMed  CAS  Google Scholar 

  77. Prince MR (1994) Gadolinium-enhanced MR aortography. Radiology 191:155–164

    PubMed  CAS  Google Scholar 

  78. Edelman RR, Zhao B, Liu C, et al. (1989) MR angiography and dynamic flow evaluation of the portal venous system. AJR Am J Roentgenol 153:755–760

    PubMed  CAS  Google Scholar 

  79. Ward J, Martinez D, Chalmers AG, et al. (1993) Rapid dynamic contrast-enhanced magnetic resonance imaging of the liver and portal vein. Br J Radiol 66:214–222

    Article  PubMed  CAS  Google Scholar 

  80. Hughes LA, Hartnell GG, Finn JP, et al. (1996) Time-of-flight MR angiography of the portal venous system: value compared with other imaging procedures. Am J Roentgenol 166:375–378

    CAS  Google Scholar 

  81. Nghiem HV, Freeny PC, Winter TC III, et al. (1994) Phase-contrast MR angiography of the portal venous system: preoperative findings in liver transplant recipients. Am J Roentgenol 163:445–450

    CAS  Google Scholar 

  82. Johnson C, Ehmann RL, Rakela J, et al. (1991) MR angiography in portal hypertension: detection of varices and imaging techniques. J Comput Assist Tomogr 15:578–584

    Article  PubMed  CAS  Google Scholar 

  83. Taylor CR, McCauley TR (1992) Magnetic resonance imaging in the evaluation of the portal venous system. J Clin Gastroenterol 14:268–273

    Article  PubMed  CAS  Google Scholar 

  84. Levy HM, Newhause JH (1988) MR imaging of portal vein thrombosis. Am J Roentgenol 151:283–286

    CAS  Google Scholar 

  85. Erden A, Erden I, Yağmurlu B, et al. (2003) Portal venous system. Evaluation with contrast-enhanced 3D MR portography. J Clin Imag 27:101–105

    Google Scholar 

  86. Lin J, Zhou KR, Chen ZW, et al. (2003) 3D contrast-enhanced MR portography and direct X-ray portography: a correlation study. Eur Radiol 13:1277–1285

    PubMed  Google Scholar 

  87. Kreft B, Strunk H, Flacke S, et al. (2000) Detection of thrombosis in the portal venous system: comparison of contrast-enhanced MR angiography with intraarterial digital substraction angiography. Radiology 216:88–92

    Google Scholar 

  88. Babb RR (1976) Splenic vein obstruction: a curable cause of variceal bleeding. Am J Dig Dis 21:512–513

    Article  PubMed  CAS  Google Scholar 

  89. Burbige EJ, Tarder G, Garson S, et al. (1978) Colonic varices. A complication of pancreatitis with splenic vein thrombosis. Dig Dis 23:752–755

    Article  CAS  Google Scholar 

  90. Sarin SK (1997) Long-term follow-up of gastric variceal schlerotherapy: an eleven-year experience. Gastrointest Endosc 46:8–14

    Article  PubMed  CAS  Google Scholar 

  91. Rengstorff DS, Binmoeller KF (2004) A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric varices in humans. Gastrointest Endosc 59:553–558

    Article  PubMed  Google Scholar 

  92. Iwase H, Maeda O, Shimada M, et al. (2001) Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastrointest Endosc 53:585–592

    Article  PubMed  CAS  Google Scholar 

  93. Oho K, Iwao T, Sumino M, et al. (1995) Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy 27:349–354

    Article  PubMed  CAS  Google Scholar 

  94. Sarin SK, Jain AK, Jain M, et al. (2002) A randomized controlled trial of cyanoacrylate versus alcohol injection in patient with isolated fundic varices. Am J Gastroenterol 97:10–15

    Article  Google Scholar 

  95. Roesch W, Rexroth G (1989) Pulmonary, cerabral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy 30:89–90

    Google Scholar 

  96. Shim CS, Cho YD, Kim JO, et al. (1996) A case of portal and splenic vein thrombosis after histoacryl injection therapy in gastric varices. Endoscopy 28:461

    Article  PubMed  CAS  Google Scholar 

  97. Tan YM, Goh KL, Kamarulzaman A, et al. (2002) Multiple systemic embolism wiyh septicemia after gastric variceal obliteration with cyanoacrylate. Gastrointest Endosc 55:276–277

    Article  PubMed  Google Scholar 

  98. Thavanathan J, Heughan C, Cummings TM (1992) Splenic vein thrombosis as a cause of variceal bleeding. Can J Surg 35:649–652

    PubMed  CAS  Google Scholar 

  99. Jones KB, deKoos PT (1984) Postembolization splenic abscess in a patient with pancreatitis and splenic vein thrombosis. South Med J 77:390–393

    PubMed  CAS  Google Scholar 

  100. Fujitani RM, Johs SM, Cobb SR, et al. (1988) Preoperarative splenic artery occlusion as an adjunct for high risk splenectomy. Am Surg 54:602–608

    PubMed  CAS  Google Scholar 

  101. Stein M, Link DP (1999) Symtomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstriction with endovascular stents. J Vasc Intervent Radiol 10:363–371

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ankara Education and Research Hospital, Ankara, Turkey

    Seyfettin Köklü

  2. Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey

    Şahin Çoban

  3. Department of Gastroenterology, Ankara Numune Hospital, Ankara, Turkey

    Osman Yüksel

  4. Department of Gastroenterology, Ankara Oncology Hospital, Ankara, Turkey

    Mehmet Arhan

  5. Karargahtepe mahallesi, Kumrulu sokak, 18/1, 06300, Keçiören, Ankara, Turkey

    Seyfettin Köklü

Authors
  1. Seyfettin Köklü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Şahin Çoban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osman Yüksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Arhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seyfettin Köklü.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Köklü, S., Çoban, Ş., Yüksel, O. et al. Left-Sided Portal Hypertension. Dig Dis Sci 52, 1141–1149 (2007). https://doi.org/10.1007/s10620-006-9307-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9307-x

Keywords

Search

Navigation