John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Left-sided portal hypertension: A rare and fatal entity Volume 29, issue 2, February 2022


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1 Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle hépato-digestif, Service d’hépato-gastro-entérologie, 1 place de l’hôpital, 67000 Strasbourg
2 IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg
3 Hôpitaux Universitaires de Strasbourg, Unité de chirurgie hépato-biliaire et pancréatique, Service de chirurgie digestive et endocrinienne, Nouvel Hôpital Civil, Pôle Hépato-digestif
4 Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamentale et Appliquée à la Cancérologie, 3 avenue Molière, 67000 Strasbourg
* Correspondance

Left-sided portal hypertension (LSPH) is a rare entity caused by various entities, pancreatic diseases (mainly chronic pancreatitis) being the most common cause. LSPH is asymptomatic in most of the cases, but non-specific chronic abdominal pain have also been described. In some cases, LSPH may present with gastro-intestinal bleeding from ruptured oesophageal or gastric varices, which could be life-threatening. Different treatment options exist, but surgical splenectomy remains the treatment of choice as it cures the LSPH, by removing the blood outflow. Recently, interventional radiology procedures have been developed, such as the splenic artery embolization. Splenic artery embolization can be associated with a partially splenic embolization to potentialized the efficacity of the procedure, enabling a “non-surgical splenectomy”, while maintaining normal immune function of spleen. Endoscopy also plays a crucial part in the therapeutic management of LSPH patients, by allowing the diagnosis of the causal lesion and its treatment (e.g., elastic band ligation for the oesophageal varices or tissues adhesive injection for gastric varices) at the same time. It is important to notice that LSPH is a curable cause of portal hypertension.