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doi:10.1111/jgh.12680

E D U C AT I O N A N D I M A G I N G

Gastrointestinal: Segmental portal hypertension caused by pancreatic mucinous cystadenoma

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Figure 1 (a) Contrast-enhanced computed tomography (CT) demonstrated a multilobular cystic tumor at the pancreatic tail, and massive splenomegaly with grossly dilated and tortuous veins; (b) CT angiogram demonstrated the isolated occlusion of splenic vein, and a venous arch was developed between the dilated right and left gastro-omental veins, forming a congested vascular bridge between the splenic and portal veins; (c) massive dilation of right and left gastro-omental veins was detected during operation.

A 30-year-old woman was admitted to our hospital for abdominal pain of two years duration. She had no history of upper gastrointestinal bleeding and her laboratory tests yielded normal results. Contrast-enhanced computerized tomography (CT) demonstrated a multilobular cystic tumor at the pancreatic tail, and massive splenomegaly with grossly dilated and tortuous veins (Fig. 1a). CT angiogram demonstrated the isolated occlusion of splenic vein, which caused the dilation of the right and left gastro-omental veins, and a venous arch was developed between them, forming a congested vascular bridge between the splenic and portal veins (Fig. 1b). The diagnosis of pancreatic segmental portal hypertension caused by pancreatic tumor was rendered. During operation, massive dilation of right and left gastroomental veins was detected (Fig. 1c). Distal pancreatectomy and splenectomy were performed successfully and pathologic exami-

nation confirmed the diagnosis of pancreatic mucinous cystadenoma. The patient was followed up to 3 years without evidence of recurrence. Segmental portal hypertension because of isolated splenic vein obstruction is a rare, but important entity as it is the only curable cause of portal hypertension by splenectomy. It is more often caused by pancreatic disease and constitutes 5–10% of all patients with portal hypertension. The diagnosis should be suspected in patients with gastroesophageal varices, but without signs of a liver disease, especially if isolated gastric varices are found. Contributed by T Li, S-Y Hu and X-T Zhi Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China

Journal of Gastroenterology and Hepatology 29 (2014) 1751 © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd

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Education and Imaging: gastrointestinal: segmental portal hypertension caused by pancreatic mucinous cystadenoma.

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