The significance of sinistral portal hypertension complicating chronic pancreatitis

George H. Sakorafas, Michael G. Sarr, David R. Farley, Michael B. Farnell

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

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. Copyright (C) 2000 Excerpta Medica Inc.

Original languageEnglish (US)
Pages (from-to)129-133
Number of pages5
JournalAmerican Journal of Surgery
Volume179
Issue number2
DOIs
StatePublished - Feb 2000

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Chronic Pancreatitis
Portal Hypertension
Splenectomy
Hypersplenism
Splenic Vein
Pancreatectomy
Varicose Veins
Hemorrhage
Thrombosis
Pancreaticojejunostomy
Hypertension
Stomach

ASJC Scopus subject areas

  • Surgery

Cite this

The significance of sinistral portal hypertension complicating chronic pancreatitis. / Sakorafas, George H.; Sarr, Michael G.; Farley, David R.; Farnell, Michael B.

In: American Journal of Surgery, Vol. 179, No. 2, 02.2000, p. 129-133.

Research output: Contribution to journalArticle

Sakorafas, George H. ; Sarr, Michael G. ; Farley, David R. ; Farnell, Michael B. / The significance of sinistral portal hypertension complicating chronic pancreatitis. In: American Journal of Surgery. 2000 ; Vol. 179, No. 2. pp. 129-133.
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