Evaluation of Splenic Embolization in Patients with Portal Hypertension and Hypersplenism (original) (raw)
Twenty-five patients with hypersplenism caused by portal hypertension were treated by repeated partial splenic embolization. Fourteen surviving patients were followed for up to six years showing a good response on peripheral blood count and bleeding tendency. Three patients died in connection with the treatment and another eight died within half a year because of the underlying liver disease. The discomfort and complications of fever, pain, pleural effusion, and abscess formation and the possibility to avoid these by repeated partial embolization under antibiotic cover are discussed. The results are compared with reports in the reviewed actual literature and the splenic embolization is given a place among the means of a successful selective symptomatic treatment of partial hypertension. nORTAL HYPERTENSION has four well-known complircations: bleeding esophageal varices, ascites, encephalopathy, and hypersplenism. In the past most of the interest has been focused on the bleeding varices and its prevention; the other complications have been more or less neglected. Today there is a tendancy to a more conservative-noninvasive-approach to portal hypertension in general. This has led surgeons and physicians including the authors to give more attention to the other complications and their treatment, selective symptomatic treatment (SST).3 A consequence of this is the new view on ascites, which in most cases can be managed by intensive diuretic treatment,'1 and if failure occurs, by peritoneal-venous shunting.28 Another consequence is the newly awaked interest in the transoesophageal sclerotherapy that has provided an outstanding tool for treatment ofbleeding oesophageal varices' '6; also in line with this is that alternative techniques for treatment of splenomegaly and hypersplenism are discussed.34 It has not been long since splenectomy was a hazardous procedure especially in patients with advanced portal hypertension and in patients with hematologic dis-
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