Left-Sided Portal Hypertension due to Malignant Lymphoma of the Pancreas: A Case Report

Tsukasa Nishida, Hiroshi Kawasaki, Kazuhiro Miyoshi, Kenji Umemoto, Keitaro Tashiro and Takashi Ishibashi

Department of Gastroenterological Surgery, Shiroyama Hospital

Left-sided portal hypertension (LSPH) is a rare disease caused by impaired splenic venous return, associated with gastric varices and splenoma in patients free of chronic liver disease. Gastric varices accompanying LSPH can be cured radically by splenectomy, but requires care when selecting the treatment mode. We report a case of malignant pancreatic lymphoma associated with this condition. A 57-year-old woman seen in May 2006 for hematemesis was found in endoscopy to have a solitary gastric varix and advised to be hospitalized for detailed examination. Preoperative diagnostic imaging showed a dilated short gastric vein and splenoma without liver cirrhosis. A tumorous lesion detected at the splenic hilus led to adiagnosis of LSPH and underwent splenectomy and tumor resection, after which the gastric varix disappeared. The resected tumor was histopathologically rated as malignant pancreatic lymphoma. The possibility of LSPH must thus be borne in mind when diagnosing and treating patients with gastric varices or splenoma but no liver cirrhosis.

Key words
left-sided portal hypertension, solitary gastric varix, malignant lymphoma

Reprint requests
Hiroshi Kawasaki Department of Gastroenterological Surgery, Shiroyama Hospital
2-8-1 Habikino, Habikino, 583-0872 JAPAN

Accepted
April 22, 2009

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