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Open Access Case report

Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

Klaus T von Trotha1*, Marcel Binnebösel1, Son Truong1, Florian F Behrendt2, Hermann E Wasmuth3, Ulf P Neumann1 and Marc Jansen4

Author Affiliations

1 Department of Surgery, University Hospital of the RWTH Aachen, Germany

2 Department of Diagnostic Radiology, University Hospital of the RWTH Aachen, Germany

3 Department of Medicine III, University Hospital of the RWTH Aachen, Germany

4 Department of Surgery, HELIOS Hospital Emil von Behring Berlin, Germany

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BMC Surgery 2011, 11:14  doi:10.1186/1471-2482-11-14

Published: 28 June 2011

Abstract

Background

Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage.

Case presentation

In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient.

Conclusion

Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

Keywords:
Splenic artery thrombosis; upper gastrointestinal bleeding; laparoscopy; splenectomy; duplex ultra sound