Sol Portal Hipertansiyon
Özet
Sol portal hipertansiyon (SPH), sistemik portal hipertansiyondan farklı olarak, siroz veya portal ven trombozu gibi karaciğer kaynaklı nedenlerden bağımsız gelişen, nadir fakat klinik olarak önemli bir durumdur. En sık etiyolojik nedenler kronik pankreatit, pankreas neoplazmaları ve psödokistler olup, bu durumlar splenik venin trombozuna veya dıştan basısına yol açarak segmental venöz basınç artışına neden olur.
Klinik olarak sıklıkla asemptomatik seyreden SPH, semptomatik olgularda fundal varis rüptürüne bağlı masif üst gastrointestinal kanama ile prezente olur. Tanı; normal karaciğer fonksiyon testleri ile birlikte endoskopi, kontrastlı bilgisayarlı tomografi, manyetik rezonans görüntüleme ve endosonografi gibi görüntüleme yöntemleriyle konur.
Tedavi yaklaşımı, hastanın klinik durumu ve komplikasyon varlığına göre değişmektedir. Akut kanama gelişen hastalarda ilk tercih endoskopik tedavi yöntemleridir; ancak bu yaklaşımlara yanıt alınamayan olgularda, splenektomi, splenik arter embolizasyonu veya splenik ven stentlemesi gibi invaziv tedavi seçenekleri gündeme gelmektedir.
SPH, tanısı zor ancak mortal komplikasyonlara yol açabilen bir klinik tablodur ve özellikle karaciğer fonksiyonları normal olan hastalarda üst gastrointestinal kanama varlığında ayırıcı tanıda mutlaka değerlendirilmelidir.
Sinistral portal hypertension (SPH) is a rare but clinically important condition. It is different from systemic portal hypertension. It does not result from liver-related causes such as cirrhosis or portal vein thrombosis. The most common causes are chronic pancreatitis, pancreatic tumors, and pseudocysts. These conditions lead to thrombosis or compression of the splenic vein. This increases segmental venous pressure.
SPH is often asymptomatic. In symptomatic cases, patients may present with massive upper gastrointestinal bleeding. This bleeding usually results from ruptured fundal varices. Liver function tests are typically normal. Diagnosis relies on imaging methods. These include endoscopy, contrast-enhanced CT, MRI, and endoscopic ultrasonography.
Treatment depends on the clinical condition and complications. Endoscopic procedures are the first option in cases with bleeding. If bleeding continues, invasive methods are used. These include splenectomy, splenic artery embolization, or splenic vein stenting.
SPH is difficult to diagnose. It may cause serious complications. It should be considered in patients with upper gastrointestinal bleeding and normal liver function.
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