胰源性门静脉高压临床罕见,为脾静脉阻塞导致脾肿大,胃和(或)食管静脉曲张,但病人肝功能正常。胃静脉曲张是胰源性门静脉高压引起的严重并发症,发生率很高,且及时诊断和治疗很困难。迄今为止,尚无最佳治疗策略的相关共识。经导管脾动脉栓塞术是替代脾切除的方法,治疗胰源性门静脉高压引起的胃静脉曲张破裂出血,安全性和有效性均良好。本文报道1例复旦大学附属中山医院消化科的病人,因自身免疫性胰腺炎导致胰源性门静脉高压,引起胃静脉曲张破裂出血。病人确诊后行经导管脾动脉栓塞术治疗,胃静脉曲张破裂出血逐渐停止,胃静脉曲张明显改善。定期随访显示,病人术后无上消化道出血复发,也无术后并发症发生。结果表明,经导管脾动脉栓塞术治疗自身免疫性胰腺炎病人胰源性门静脉高压相关胃静脉曲张破裂出血,是微创安全有效的措施。

Pancreatic sinistral portal hypertension (PSPH) is a rare entity resulting from splenic vein obstruction and is characterized by splenomegaly, gastric and/or esophageal varices with normal liver function. PSPH-related gastric varices is one of severe complications with high incidence and is difficult for prompt diagnosis and treatment. To date, there is no consensus on treatment strategy. Splenic artery embolization (SAE) has been considered as an alternative strategy to splenectomy with satisfactory safety and efficacy for treatment of gastric bleeding caused by PSPH. Here we reported one case with autoimmune pancreatitis-related PSPH with gastric bleeding in Department of Gastroenterology Zhongshan Hospital. Treatment with transcatheter SAE led to gradual stop of gastric bleeding and much improvement of gastric varices. Follow-up study indicated that recurrence of upper gastrointestinal bleeding was not present without postoperative complication. The results suggest that SAE is a minimally invasive, safe and effective treatment strategy for controlling PSPH-related gastric variceal bleeding in the patient with autoimmune pancreatitis.