Stepwise partial splenic embolization for portal hypertension based on a new concept: Splanchnic caput Medusae

Fumio Chikamori; Niranjan Sharma; Satoshi Ito; Kai Mizobuchi; Koji Ueta; Haruka Takasugi; Sawaka Yukishige; Hisashi Matsuoka; Norihiro Hokimoto; Hiromichi Yamai; Kazuhisa Onishi; Nobuyuki Tanida; Nobumasa Hamaguchi

doi:10.1016/j.radcr.2020.12.020

Stepwise partial splenic embolization for portal hypertension based on a new concept: Splanchnic caput Medusae

Radiol Case Rep. 2020 Dec 24;16(3):564-570. doi: 10.1016/j.radcr.2020.12.020. eCollection 2021 Mar.

Affiliations

¹ Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan.
² Adv Train Gastroint & Organ Transp Surgery, 12 Scotland Street Dunedin, 9016, New Zealand.
³ Department of Radiology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan.

Abstract

Management of splenomegaly with thrombocytopenia is important in the treatment of portal hypertension. We propose a new concept: "Splanchnic Caput Medusae" in which enlarged spleen is her face and portal collateral pathways are her snake hairs. We report 2 demonstrable cases who were treated based on this new concept. Case 1 with refractory esophageal varices and splenomegaly was treated by stepwise partial splenic embolization (PSE) and endoscopic injection sclerotherapy with ligation. Spleen/liver volume ratio changed from 0.33 to 0.10. Hepatic venous pressure gradient changed from 19 to 14 mmHg. Case 2 with mesenteric shunt and splenomegaly was treated by stepwise PSE and retrograde obliteration. Spleen/liver volume ratio changed from 0.70 to 0.05. Hepatic venous pressure gradient changed from 11 to 7 mmHg. In these 2 cases, 3D-CT reconstruction images after treatment revealed that spleen- portal system reversed almost to normal form. We conclude that splenomegaly and portal collateral pathways could be considered as "Splanchnic Caput Medusae" and have to be treated by stepwise PSE.

Keywords: Endoscopic injection sclerotherapy with ligation; Liver fibrosis; Partial splenic embolization; Portal hypertension; Retrograde obliteration; Splanchnic caput Medusae.

Publication types

Case Reports