Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1365-1370
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1365
Partial embolization as re-treatment of hypersplenism after unsuccessful splenic artery ligation
Zheng-Ju Xu, Lian-Qiu Zheng, Xing-Nan Pan
Zheng-Ju Xu, Lian-Qiu Zheng, Xing-Nan Pan, Clinical Liver Center, 180th Hospital of the People’s Liberation Army, Quanzhou 362000, Fujian Province, China
Author contributions: Xu ZJ conceived and coordinated the study, and participated in data collection and manuscript writing; Pan XN participated in the study design, data collection, and manuscript writing; Zheng LQ participated in data collection and manuscript writing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zheng-Ju Xu, Associate Chief Physician, Clinical Liver Center, 180th Hospital of the People’s Liberation Army, No. 180, Huayuan Road, Fengze District, Quanzhou 362000, Fujian Province, China. h180@163.com
Telephone: +86-595-28919590 Fax: +86-595-28919100
Received: June 13, 2014
Peer-review started: June 13, 2014
First decision: July 21, 2014
Revised: August 3, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: January 28, 2015
Processing time: 228 Days and 14.3 Hours
Abstract

Ligation of splenic artery (LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a 47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopenia and thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization (PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.

Keywords: Hypersplenism; Partial splenic embolization; Splenic artery ligation; Liver cirrhosis; Leukocytopenia; Thrombocytopenia

Core tip: Ligation of splenic artery (LSA) is used for the treatment of hypersplenism due to liver cirrhosis. However, hypersplenism is not always improved following LSA. We report a case of cirrhosis and hypersplenism which underwent LSA treatment, but failed to respond as manifested by persistent severe leukocytopenia and thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries supplying the spleen. Partial splenic embolization (PSE) was performed through those arteries resulting in increased leukocyte and thrombocyte counts that remained within the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.