J Lipid Atheroscler.  2014 Dec;3(2):111-115. 10.12997/jla.2014.3.2.111.

Idiopathic Splenic Vein Thrombosis Presenting as Splenic Infarction and Consequent Gastric Variceal Bleeding

Affiliations
  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dukkyung.kim@samsung.com
  • 4Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Left-sided portal hypertension and consequent gastric varices can occur in patients with isolated splenic vein thrombosis. It is a rare but clinically significant and curable cause of gastrointestinal hemorrhage. Our patient, a 20-year-old woman, with left flank pain was diagnosed with having idiopathic splenic vein thrombosis with resultant splenic infarction. Thorough workups for the possible etiologies of splenic vein thrombosis were all negative. After six months of anticoagulation, follow-up computed tomography revealed formation of gastric varices; one month following the discovery, she developed gastrointestinal bleeding. Splenectomy was performed, resulting in the resolution of gastric varices.

Keyword

Splenic vein thrombosis; Left-sided portal hypertension; Gastric varices; Splenic infarction

MeSH Terms

Esophageal and Gastric Varices*
Female
Flank Pain
Follow-Up Studies
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Hypertension, Portal
Splenectomy
Splenic Infarction*
Splenic Vein*
Thrombosis*
Young Adult

Figure

  • Fig. 1 Contrast-enhanced CT of the abdomen showing splenic vein thrombosis and splenic infarction. (A) Transverse CT image during the portal-venous phase revealed a wedge-shaped low-density lesion (white arrowhead) on superomedial aspect of the spleen, which is considered to be splenic infarction, (B) Image from the same CT scan also demonstrated splenic vein thrombosis (arrow) at the splenic hilum portion.

  • Fig. 2 Follow-up CT images showing venous collaterals and gastric varices. (A) Transverse CT image during the portal-venous phase revealed venous collaterals (arrow) around the splenic hilum, (B) Image from the same CT scan also demonstrated a conglomerate of gastric varices (arrow), (C) Follow-up CT scan taken 5 months after splenectomy showed resolution of gastric varices.

  • Fig. 3 Gastrofiberscopic findings. (A) Gastric varices with bleeding induced by the gag reflex were demonstrated by endoscopy, (B) Two weeks after splenectomy, gastrofiberscope showed complete resolution of gastric varices.


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