%0 Journal Article
%T Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass
%A Klaus T von Trotha
%A Marcel Binneb£¿sel
%A Son Truong
%A Florian F Behrendt
%A Hermann E Wasmuth
%A Ulf P Neumann
%A Marc Jansen
%J BMC Surgery
%D 2011
%I BioMed Central
%R 10.1186/1471-2482-11-14
%X 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.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.Among the most common causes of upper gastrointestinal bleeding are ulcers of the duodenum or stomach, accounting for approximately 50% of all cases. These are followed by erosions of the duodenum or stomach, varicosis of the oesophagus or gastric fundus, and reflux disease [1]. It has been shown that 4/5 of all ulcers are located on the lesser curvature of the stomach, while more atypical localisations include corpus, fundus, and greater curvature of the stomach.Gastric varicosis is often the result of portal hypertension in the liver. Such portal hypertension is caused by simultaneous increases in the portal vascular territory, the so-called "backward flow", as well as increased arterial blood flow within the splanchnic vascular territory, the "forward flow". This results in the development of a collateral circulation from the portal to the caval venous system. It is these portal gastric o
%K Splenic artery thrombosis
%K upper gastrointestinal bleeding
%K laparoscopy
%K splenectomy
%K duplex ultra sound
%U http://www.biomedcentral.com/1471-2482/11/14