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

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

Radiology Case Reports (Mar 2021)

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

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

Affiliations

Fumio Chikamori, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan; Corresponding author.
Niranjan Sharma, MD: Adv Train Gastroint & Organ Transp Surgery, 12 Scotland Street Dunedin, 9016, New Zealand
Satoshi Ito, MD: Department of Radiology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Kai Mizobuchi: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Koji Ueta, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Haruka Takasugi: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Sawaka Yukishige: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Hisashi Matsuoka, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Norihiro Hokimoto, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Hiromichi Yamai, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Kazuhisa Onishi, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Nobuyuki Tanida, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
Nobumasa Hamaguchi, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan

Journal volume & issue: Vol. 16, no. 3
pp. 564 – 570

Abstract

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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.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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