Spontaneous Splenic Hemorrhage and Portal Hypertension in Pregnancy: A Combined Catheter Based and Surgical Approach

Estin Yang, Mia DeBarros, Michael Pfister, Seth Izenberg and Riyad Karmy-Jones

Department of Trauma/Critical Care, Legacy Emanuel Hospital, Portland
Department of Interventional Radiology, Legacy Emanuel Hospital, Portland
Department of Thoracic Surgery, Legacy Emanuel Hospital, Portland

^*Correspondance to: Riyad Karmy-Jones 

 PDF  Full Text DOI: 10.25107/2474-1647.2201

Abstract

Objectives: To review the management of portal hypertension and splenic hemorrhage in pregnancy.Methods: A retrospective case review.Results: A 22-year-old female, with past history of portal hypertension, variceal hemorrhage and thrombocytopenia presented at 22 weeks of pregnancy with spontaneous splenic hemorrhage. Her portal hypertension was a consequence of intra-hepatic sclerosis following treatment of acute cell lymphoma in childhood. Because of the risk of variceal hemorrhage as pregnancy progressed, Transjugular Hepatic Portosystemic Shunt (TIPS) was performed first, followed a few days later by splenic artery embolization and splenectomy in a combined setting. The patient has subsequently delivered a healthy girl.Conclusion: In the era of hybrid suites, catheter and surgical based approaches can more easily be combined. In this setting, the patient had dual risks as pregnancy advanced: variceal hemorrhage and splenic rupture. The combined approach permitted splenectomy without the need for transfusion.

Keywords

Variceal; Splenic; Hemorrhage; Embolization; TIPS

Cite the article

Yang E, DeBarros M, Pfister M, Izenberg S, Karmy-Jones R. Spontaneous Splenic Hemorrhage and Portal Hypertension in Pregnancy: A Combined Catheter Based and Surgical Approach. Clin Surg. 2018; 3: 2201.