The diagnosis and treatment of pancreatic segmental portal hypertension with upper gastrointestinal bleeding

Objective To explore the diagnosis and treatment of pancreatic segmental portal hypertension with upper gastrointestinal bleeding.Methods From January 2000 to February 2011, fourteen cases of pancreatic segmental portal hypertension with upper gastrointestinal bleeding in our hospital were retrospectively analyzed.Results The underlying pancreatic diseases were mass of pancreatic body and tail (n=6) , pancreatic pseudocyst (n=4) and chronic pancreatitis (n=4) .All the patients presented with hematemesis or melena and four patients manifested hemorrhagic shock.All the patients had no evidence of cirrhosis, ascites and abnormal hepatic function.Endoscopy and endoscopic ultrasound revealed that all the patients had varices in the gastric fundus and two patients had oesophageal varices simultaneously.Eight patients presented with splenomegaly and hypersplenism.All the patients underwent operation treatment.Nine patients were followed up for 5 months to 8 years, and there were no rebleeding.Conclusion Isolated gastric varices, splenomegalia and hypersplenism, normal liver function and the history of pancreatic disease could help to diagnose.Pancreatic segmental portal hypertension could be cured by splenectomy and extensive pericardial devascularization, and the management of primary pancreas disease should also be emphasized.