Left-Sided Portal Hypertension: A Clinical Challenge

Abstract

c i t i s i Left-sided portal hypertension (LSPH), also known as segmental, regional, localized, compartmental, lineal, splenoportal, or sinistral hypertension is a rare, but life threatening cause of upper gastrointestinal bleeding. It usually occurs as a result of isolated obstruction of the splenic vein. The incidence of LSPH has increased over the past three decades due to increased awareness of the entity and advances in diagnostic approaches. Since most patients are asymptomatic and experience no complications, its exact incidence is unknown. However, it accounts for less than 5% of all patients with portal hypertension.1 To date, less than 500 cases of LSPH have been reported in all. Most of the studies in the literature comprise a limited number of patients and are usually retrospective.2,3 Due to its low incidence, it is likely that most cases of sinistral hypertension are initially misdiagnosed as a generalized portal hypertension. Blood flow through the splenic vein may be blocked secondary to either thrombosis formation or neighboring mass effect.1 Following obstruction, splenic blood typically drains through the short gastric veins to the stomach. In the gastric wall veins of the fundus, blood flow and pressure increase and submucosal structures consequently dilate, producing gastric varices. Fortunately, due to several anatomic variations, obstruction of the splenic vein may not always result