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Fundal variceal bleeding after correction of portal hypertension in patients with cirrhosis.
Gastrointest Endosc. 2003 Jul; 58(1):122-7.GE

Abstract

BACKGROUND

Management of fundal variceal bleeding is challenging. Generally, a portal pressure of greater than 12 mm Hg is required for bleeding to occur, but fundal variceal bleeding persists in some patients despite adequate portal decompression. Methods and Observations: Five patients with cirrhosis evaluated for upper GI hemorrhage from fundal varices underwent upper endoscopy followed by angiography, which documented a spontaneous splenogastrorenal shunt.

OBSERVATIONS

All patients bled at portal pressures of less than 12 mm Hg. Despite correction to values of 0 to 7 mm Hg, bleeding recurred in 4 of 5 patients, 3 of whom required repeated embolization sessions because of reformation of the splenogastrorenal collateral.

CONCLUSIONS

Hemodynamically significant bleeding can occur from gastric fundal varices supplied by a splenogastrorenal collateral despite low portal venous pressure. Furthermore, portal decompression alone does not prevent recurrent bleeding via this collateral. Selective catheterization of the splenic vein is often needed to document its presence. To tailor effective therapy, accurate recognition of this collateral and its hemodynamic features are essential.

Authors+Show Affiliations

Northwestern University Medical School, Division of Hepatology, Chicago, Illinois 60611, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

12838239

Citation

Rinella, Mary E., et al. "Fundal Variceal Bleeding After Correction of Portal Hypertension in Patients With Cirrhosis." Gastrointestinal Endoscopy, vol. 58, no. 1, 2003, pp. 122-7.
Rinella ME, Shah D, Vogelzang RL, et al. Fundal variceal bleeding after correction of portal hypertension in patients with cirrhosis. Gastrointest Endosc. 2003;58(1):122-7.
Rinella, M. E., Shah, D., Vogelzang, R. L., Blei, A. T., & Flamm, S. L. (2003). Fundal variceal bleeding after correction of portal hypertension in patients with cirrhosis. Gastrointestinal Endoscopy, 58(1), 122-7.
Rinella ME, et al. Fundal Variceal Bleeding After Correction of Portal Hypertension in Patients With Cirrhosis. Gastrointest Endosc. 2003;58(1):122-7. PubMed PMID: 12838239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fundal variceal bleeding after correction of portal hypertension in patients with cirrhosis. AU - Rinella,Mary E, AU - Shah,Dhiren, AU - Vogelzang,Robert L, AU - Blei,Andrès T, AU - Flamm,Steven L, PY - 2003/7/3/pubmed PY - 2003/12/3/medline PY - 2003/7/3/entrez SP - 122 EP - 7 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 58 IS - 1 N2 - BACKGROUND: Management of fundal variceal bleeding is challenging. Generally, a portal pressure of greater than 12 mm Hg is required for bleeding to occur, but fundal variceal bleeding persists in some patients despite adequate portal decompression. Methods and Observations: Five patients with cirrhosis evaluated for upper GI hemorrhage from fundal varices underwent upper endoscopy followed by angiography, which documented a spontaneous splenogastrorenal shunt. OBSERVATIONS: All patients bled at portal pressures of less than 12 mm Hg. Despite correction to values of 0 to 7 mm Hg, bleeding recurred in 4 of 5 patients, 3 of whom required repeated embolization sessions because of reformation of the splenogastrorenal collateral. CONCLUSIONS: Hemodynamically significant bleeding can occur from gastric fundal varices supplied by a splenogastrorenal collateral despite low portal venous pressure. Furthermore, portal decompression alone does not prevent recurrent bleeding via this collateral. Selective catheterization of the splenic vein is often needed to document its presence. To tailor effective therapy, accurate recognition of this collateral and its hemodynamic features are essential. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/12838239/Fundal_variceal_bleeding_after_correction_of_portal_hypertension_in_patients_with_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016510703014883 DB - PRIME DP - Unbound Medicine ER -