Diagnosis and treatment of pancreatogenic portal hypertension

Objective To investigate the causes, clinical manifestations and treatment of pancreatogenic portal hypertension (PPH)． Methods A retrospective analysis was carried out in 34 patients with portal hypertension complicating with pancreatic diseases in Chinese PLA General Hospital from May 2009 to May 2015． Medical records of these patients were reviewed, including demographics, etiologies, clinical manifestations, endoscopic classification, laboratory tests, imaging studies and treatment． Results The main diagnostic methods were endoscopy, ultrasonography (US) and computerized tomography (CT)． Of the 34 cases, pancreatic cancer was found in 4 cases, solid pseudopapillary neoplasm of the pancreas in 1 case, pancreatic cyst in 4 cases, chronic pancreas in 20 cases, acute pancreas in 5 cases． Thirty-one patients presented with hematemesis or melena and one patient with hemorrhagic shock． All patients had no manifestations of cirrhosis, ascites and abnormal hepatic function, while splenomegaly was presented in all patients． Endoscopy and endoscopic ultrasound revealed that all patients had gastroesophageal varices． Ten patients underwent operation treatment, and the remaining cases received conservative treatment including endoscopic tissue adhesive injection． Follow-up was done after acute bleeding was controlled． No postoperative bleeding occurred in the period of follow-up．One case died of pancreatic cancer． Conclusion Isolated gastric varices, splenomegalia, liver function and a history of pancreatic disease are helpful in diagnosing PPH． Based on findings of endoscopy and other imaging methods, PHH can be diagnosed easily, however, it should have differential diagnosis with liver-derived portal hypertension． Endoscopic tissue adhesive injection can effectively control acute variceal bleeding． Right diagnosis and efficient management are the right points for therapy of PPH．