Wong Hock-Khiam, Kuo Hsing-Tao, Tsai Sun-Lung, Uen Yih-Huei, Tzeng Wen-Sheng
Division of Gastroenterology, Department of Internal Medicine, Chi-Mei Foundation Hospital, Tainan, Taiwan.
J Formos Med Assoc. 2004 Aug;103(8):640-3.
Left-sided portal hypertension due to splenic vein stenosis is a very rare disease. We report a case of this condition in a 21-year-old woman who suffered from a first episode of tarry stool passage with fresh blood vomiting. Panendoscopy showed isolated gastric varices while sonography showed a normal liver but the presence of splenomegaly with prominent collateral circulations. Further imaging studies, including abdominal computed tomography, splenoportography and percutaneous transhepatic portography, revealed a focal stenotic proximal splenic vein resulting in left-sided portal hypertension. The collateral circulation ran from the short gastric veins via the left gastric veins into the main portal vein. The intraportal venous pressure was within normal limits. Splenectomy was performed and near normal wedge liver biopsy pathology confirmed non-cirrhotic extrahepatic portal hypertension. The patient had no further variceal bleeding after surgery.
脾静脉狭窄所致左侧门静脉高压是一种非常罕见的疾病。我们报告一例21岁女性患者，该患者首次出现柏油样便并伴有鲜血呕吐。全内镜检查显示孤立性胃静脉曲张，而超声检查显示肝脏正常，但存在脾肿大并伴有明显的侧支循环。进一步的影像学检查，包括腹部计算机断层扫描、脾门静脉造影和经皮经肝门静脉造影，发现脾静脉近端局灶性狭窄导致左侧门静脉高压。侧支循环从胃短静脉经胃左静脉进入门静脉主干。门静脉内压力在正常范围内。进行了脾切除术，近乎正常的楔形肝活检病理证实为非肝硬化性肝外门静脉高压。患者术后未再发生静脉曲张出血。
