Gastric Bleeding After Laparoscopic Spleen-Preserving Distal Pancreatectomy

Sven-Petter Haugvik, MD, Bård Ingvald Røsok, MD, PhD, Rune Andersen, MD, PhD, Bjørn Edwin, MD, PhD

Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Drs. Haugvik, Røsok, Edwin). Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Drs. Haugvik, Edwin). Department of Radiology and Nuclear Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Dr. Andersen). Interventional Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Dr. Edwin).

ABSTRACT

Introduction: Laparoscopic spleen-preserving distal pancreatectomy for tumors of the pancreatic body and tail is becoming increasingly established at hepato-pancreato-biliary surgical departments worldwide. Spleen preservation is only recommended in benign or borderline lesions of the pancreas. We present a rare complication after laparoscopic spleen-preserving distal pancreatectomy.

Case Description: A 43-year-old woman with multiple endocrine neoplasia type 1 syndrome was referred to our department for surgical removal of a tumor in the pancreatic tail. A laparoscopic spleen-preserving distal pancreatectomy, including preservation of the splenic vessels, was performed. The patient was discharged on the tenth postoperative day after percutaneous drainage of peripancreatic fluid and transient fever. About 4 months postoperatively, she was admitted to her local hospital with recurrent anemia. Gastroscopy and abdominal computed tomography did not show any signs of bleeding, but prominent gastric varices and occlusion of the splenic vein were observed. The patient was referred back to our department, where an embolization of the splenic artery was performed with a percutaneous endovascular technique. She was discharged after 2 days with no recurrent anemia thereafter.

Discussion: Splenic artery embolization can be an effective treatment option for gastric variceal bleeding caused by splenic vein occlusion after laparoscopic spleen-preserving distal pancreatectomy.

Key Words: Laparoscopic pancreatic surgery, Distal pancreatectomy, Splenic artery embolization, Left-sided portal hypertension, Gastric variceal bleeding.

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