Online ISSN: 2515-8260

Keywords : portal hypertension

Splenomegaly in Pregnancy-Evaluation of Causes and Pregnancy Outcome- A Case Series

Dr. V. Prathyusha, Dr. Anumpama Hari, Dr Shalini , Dr. K. Vishali

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3117-3122

Background: Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and fetus. There is paucity of studies in the literature to guide clinicians for the management of this condition.
Materials and Methods: We reviewed the course of pregnancy, maternal and fetal outcomes of 6 pregnant women with massive splenomegaly who were managed in our unit during 2019-2021.
Results: We reviewed the course and outcome of 6 pregnant women with massive splenomegaly {>17cm}. Patients characteristics including age, history (fever, thrombotic episodes, gastrointestinal haemorrhage), and treatment history were recorded. Laboratory investigations (complete blood counts, liver function tests and viral markers); ultrasonography with colour Doppler (to assess the echotexture of the liver, and measure the spleen size, liver span and diameter of the portal vein), upper gastrointestinal (GI) endoscopy; autoimmune work-up (lupus anticoagulant and antiphospholipid antibody) and peripheral smear for malaria parasite was done as indicated. The course of pregnancy, mode of delivery, and maternal and fetal outcome were noted.
Conclusion: Pregnancy with massive splenomegaly poses a challenge because of diverse etiology and potentially adverse outcomes. Multidisciplinary care in a tertiary center can help optimize the outcome

Splenic Arteriovenous Fistula with Non-Cirrhotic Portal Hypertension : a Case Report

Vasan, Arief Rakhman Hakim, Fendy Matulatan .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5380-5383

Background:As an uncommon cause of portal hypertension, splenic arteriovenous fistula (SAVF) may show as stomach discomfort, diarrhea, ascites, and/or hematemesis. Formation of a fistula may be traumatic or spontaneous..[1,2]
Case Presentation : A 7 years old Female with history of recurrent episodes of hematemesis, endoscopy in 2021 showed tortous esophageal varices with multiple site of bleeding, Thoraco-abdominal CTA in 2021 showed thrombus in portal vein and Splenomegaly. During operation there was incidental finding of SAVF, the fistula then ligated and followed by retrograde thrombectomy portal vein and distal splenorenal shunt. Post operative abdominal ultrasound showed portal vein diameter 6mm with velocity 15.7cm/s, there was no recurrent hematemesis and patient was discharge on 7th day post operation.
Disscussion : Several misunderstandings regarding shunt surgery in the pediatric age range, such as increased failure rates in children less than 10 years, especially those with veins smaller than 10 mm in diameter. No long-term evidence exist to support these assumptions. Moreover, shunts are cost-effective, less distressing psychologically than recurrent endoscopic operations, and promote normal physical growth in youngsters. [4,5] Distal splenorenal shunt surgery provides a safe and reliable alternative to recurrent endoscopic operations for the avoidance of bleeding and improvement of hypersplenism in children with portal hypertension, according to a study published in the journal Pediatric Surgery.

Updated Management and Prediction of Gastroesophageal Varices in Cirrhotic Patients

Mohammed Ibrahim Ali, Aya Magdy Tawfik, Mohamed Mohamed Refaey, Sameh Saber Bayoumi, Ahmed F. Omar

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4323-4338

Background: Cirrhosis is a condition that result from chronic liver disease, and is characterized
by advanced fibrosis, scarring, and formation of regenerative nodules leading to architectural
distortion. Patients with cirrhosis are at increased risk of numerous complications that can
occur secondary to portal hypertension, abnormal liver synthetic function, or combination of
both. Portal hypertension (PH) is an increase in portal pressure beyond the threshold of 10
mmHg (clinically significant portal hypertension, CSPH) increases the risk of gastroesophageal
varices (GEVs). Gastroesophageal varices (GEV) are the most relevant porto-systemic
collaterals resulting from clinically significant portal hypertension, for which the presence of
EV is an independent predictor of mortality. Variceal bleeding is one of the most fatal
complications of portal hypertension which caused by rupture of gastric and mainly OV with a
mortality rate of 17% to 57%. Non-invasive predication of varices in cirrhotic patients is useful
as generalized screening of all cirrhotic patients by endoscopy would increase the work load of
endoscopy units.