Hakim Seifeldin, Bortman Jared, Orosey Molly, Cappell Mitchell S
Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
Medicine (Baltimore). 2017 Mar;96(13):e6413. doi: 10.1097/MD.0000000000006413.
A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization.
A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up.
Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA.
A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not the secondarily constricted SV.
本文报告了一例由左胃动脉假性动脉瘤压迫脾静脉导致左侧门静脉高压引起上消化道出血的罕见病例，该病例通过假性动脉瘤栓塞术成功治疗。
一名41岁男性，既往有复发性酒精性胰腺炎病史，出现呕血和腹痛症状48小时。体格检查发现腹部柔软，无腹部杂音、无搏动性腹部肿块，也无慢性肝病体征。血红蛋白从12.3g/dL急剧降至9.3g/dL。肝功能生化参数及常规凝血指标均完全在正常范围内。腹部CT显示胰腺周围有一个5厘米宽的肿块，压迫胃部并压迫脾静脉。食管胃十二指肠镜检查显示门静脉高压性胃病有渗血，胃贲门和胃底有小的无出血性静脉曲张，外部肿块压迫胃部，无食管静脉曲张。磁共振胰胆管造影（MRCP）和血管造影显示该肿块有血管，起源于左胃动脉，压迫脾静脉中段但无脾静脉血栓形成，并导致左侧门静脉高压。血管造影时，对假性动脉瘤进行了血管栓塞并闭塞。在8周的随访期间，患者无症状，无进一步出血，血红蛋白水平稳定。
对14例已报道的左胃动脉假性动脉瘤病例的文献回顾显示，本文报道的由左胃动脉假性动脉瘤压迫脾静脉导致左侧门静脉高压引起急性上消化道出血的病例是新颖的；之前报道的一名患者有严重贫血，但无与左胃动脉假性动脉瘤导致左侧门静脉高压相关的急性上消化道出血。
一名患者因左胃动脉假性动脉瘤压迫脾静脉导致左侧门静脉高压引起上消化道出血，通过血管造影闭塞假性动脉瘤进行治疗，解除了脾静脉压迫，止住了上消化道出血。该综合征的主要治疗方法应是闭塞假性动脉瘤，而非继发性受压的脾静脉。
