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Annals of Gastroenterology
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2007 (EN)
Splenomegaly and left sided portal hypertension (EN)

E. Kafantari,1 S. É. Kokoris,3 B.Smyrniotis,1 G. A. Pangalis, D.Voros,1 E. Mallas,1 A. Antoniou

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 (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 18, No 3 (2005) (EN)

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