Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2023; 29(24): 3922-3931
Published online Jun 28, 2023. doi: 10.3748/wjg.v29.i24.3922
Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review
Lisa-Michaela Füssel, Rene Müller-Wille, Patrick Dinkhauser, Walter Schauer, Harald Hofer
Lisa-Michaela Füssel, Patrick Dinkhauser, Harald Hofer, Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
Rene Müller-Wille, Department of Radiology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
Walter Schauer, Department of Abdominal Surgery, Klinikum Wels-Grieskirchen, Wels 4600, Austria
Author contributions: Füssel LM and Hofer H performed the research and drafting of the manuscript; Dinkhauser P, Müller-Wille R and Schauer W did a critical revision of the manuscript for important intellectual content; Füssel LM and Müller-Wille R performed image editing; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Harald Hofer, MD, Professor, Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, Wels 4600, Austria.harald.hofer@klinikum-wegr.at
Received: February 1, 2023
Peer-review started: February 1, 2023
First decision: April 14, 2023
Revised: April 27, 2023
Accepted: May 24, 2023
Article in press: May 24, 2023
Published online: June 28, 2023
Processing time: 147 Days and 1.2 Hours
Abstract
BACKGROUND

Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.

CASE SUMMARY

A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.

CONCLUSION

Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

Keywords: Pancreatitis-induced splenic vein thrombosis; Gastrointestinal hemorrhage; Colonic varices; Splenic vein stenting; Segmental/sinistral hypertension; Case report

Core Tip: Splenic vein thrombosis (SVT) is a complication of pancreatitis and can lead to development of varices with a high risk of gastrointestinal bleeding. While clear guidelines are lacking, splenectomy or splenic artery embolization are often employed. We present a rare case of recurrently bleeding colonic varices (CV) due to pancreatitis-induced (PI) SVT. In an interdisciplinary board, transhepatic recanalization of the splenic vein and consecutive stenting, as well as coiling of aberrant veins was decided and successfully performed. Follow-up revealed complete regression of varices. According to our knowledge, there is no case report in English literature describing stenting of PISVT in a patient with CV.