Document Detail

The significance of sinistral portal hypertension complicating chronic pancreatitis.
MedLine Citation:
PMID:  10773149     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sinistral portal hypertension, a localized (left-sided) form of portal hypertension may complicate chronic pancreatitis as a result of splenic vein thrombosis/obstruction. AIM:To determine appropriate surgical strategy for patients with splenic vein thrombosis/obstruction secondary to chronic pancreatitis. METHODS: We reviewed our experience with operative management of 484 consecutive patients with histologically documented chronic pancreatitis treated between 1976 and 1997. The diagnosis of sinistral portal hypertension was based on clinical presentation, preoperative endoscopic and radiographic imaging, and operative findings. "Symptomatic," herein defined, denotes those patients with sinistral hypertension and either gastrointestinal bleeding or hypersplenism. "Asymptomatic" patients were those with sinistral hypertension alone. RESULTS: Sinistral portal hypertension was present in 34 of the 484 patients (7%). Gastric or gastroesophageal varices were confirmed in 12 patients (35%), of whom 6 had variceal bleeding and 4 had hypersplenism (25%). All symptomatic patients were treated by splenectomy alone or in conjunction with distal pancreatectomy. Splenectomy at the time of pancreatectomy for primary pancreatic symptoms was also performed in 15 patients with (asymptomatic) sinistral portal hypertension. None of the 23 patients who had splenectomy rebled in mean follow-up of 4.8 years. In contrast, 1 of the 11 patients with asymptomatic sinistral portal hypertension who underwent pancreatic surgery without splenectomy died of later variceal bleeding 3 years after lateral pancreatojejunostomy. CONCLUSIONS: Symptomatic sinistral portal hypertension is best treated by splenectomy. Concomitant splenectomy should be strongly considered in patients undergoing operative treatment of symptomatic chronic pancreatitis if sinistral portal hypertension and gastroesophageal varices are also present.
G H Sakorafas; M G Sarr; D R Farley; M B Farnell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  179     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-08-30     Completed Date:  2000-08-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  129-33     Citation Subset:  AIM; IM    
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55902, USA.
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MeSH Terms
Cause of Death
Chronic Disease
Esophageal and Gastric Varices / etiology
Follow-Up Studies
Gastrointestinal Hemorrhage / etiology
Hypersplenism / etiology
Hypertension, Portal / classification*,  etiology
Middle Aged
Pancreatitis / complications*
Splenic Vein / pathology,  surgery
Tomography, X-Ray Computed
Venous Thrombosis / etiology,  surgery

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