Left-sided portal hypertension: Update and proposition of management algorithm.
Fiche publication
Date publication
décembre 2023
Journal
Journal of visceral surgery
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BAUMERT Thomas, Dr HABERSETZER François, Pr PESSAUX Patrick, Dr VENKATASAMY Aina
Tous les auteurs :
Mayer P, Venkatasamy A, Baumert TF, Habersetzer F, Pessaux P, Saviano A, Felli E
Lien Pubmed
Résumé
Left-sided or segmental portal hypertension (SPHT) is a rare entity, most often associated with pancreatic disease or antecedent pancreatic surgery. The starting point is splenic vein obstruction secondary to local inflammation or, less often, extrinsic compression. SPHT leads to splenomegaly and development of collateral porto-systemic venous circulation. SPHT should be suspected in patients with pancreatic history who present with episodic upper gastrointestinal bleeding and splenomegaly with normal liver function tests. The most common clinical presentation is major upper gastrointestinal bleeding secondary to rupture of esophageal and/or gastric varices. At the present time, there are no management recommendations for SPHT, particularly when the patient is asymptomatic. In patients with upper gastro-intestinal bleeding, hemostasis can be obtained either by medical or interventional means according to patient status and available resources. For symptomatic patients, splenectomy is the reference treatment. Recently, less invasive, radiologic procedures, such as splenic artery embolization, have been developed as an alternative to surgery. Additionally, sonography-guided endoscopic hemostasis can also be envisioned, leading to the diagnosis and treatment of the lesion by elastic band ligation or by glue injection into the varices during the same procedure. The goal of this article is to describe the pathophysiological mechanisms behind SPHT and its clinical manifestations and treatment, based on a review of the literature. Because of the absence of recommendations for the management of SPHT, we propose a decisional algorithm for the management of SPHT based on the literature.
Mots clés
Acute pancreatitis, Chronic pancreatitis, Endoscopic hemostasis, Left-sided portal hypertension, Pancreatic surgery, Segmental portal hypertension, Splenectomy, Splenic vein thrombosis, Upper gastro-intestinal bleeding
Référence
J Visc Surg. 2023 12 22;: