Systemic Thrombolysis for Isolated Splenic Vein Thrombosis Secondary to Oral Contraceptives: A Case Report

Figures & data

Figure 1 Contrast-enhanced CT images performed on August 7 (A), August 14 (B), August 22 (C), and September 26 (D) showing change of isolated splenic vein thrombosis (red arrow).

Figure 2 Upper gastrointestinal endoscopic images. There were no varices in the esophagus (A) or gastric fundus (B).

Table 1 Reported Cases of Isolated Splenic Vein Thrombosis or Occlusion: An Overview

First Author (Country, Year)	Patient Age/Sex	Etiology	Symptoms	Diagnostic Method	Therapy
Sutton (USA, 1970)^Citation7	40/M	Pancreatic pseudocyst, trauma	GIB	Splenic venogram	Splenectomy
Khan (USA, 1977)^Citation8	39/M	Chronic pancreatitis	GIB	Angiography	Splenectomy
Bunt (USA, 1983)^Citation9	45/M	Pancreatitis	GIB	Angiography	Splenectomy
Røder (NA, 1984)^Citation10	51/NA	Pancreatic pseudocyst	GIB	Angiography	Splenectomy
	50/NA	Previous gastric surgery
Madsen (NA, 1986)^Citation11	NA	NA	GIB	NA	Splenectomy
Singh (India, 1990)^Citation12	NA	Tuberculosis	GIB, bowel obstruction	NA	Splenectomy, jejunal resection, antituberculous
Perisić-Savić (Yugoslavia, 1991)^Citation13	31/F	Pregnant	Asymptomatic	Ultrasonography	Splenectomy
Møller (Denmark, 1997)^Citation14	33/M	Pancreatic abscess	GIB	NA	Splenectomy
Tsuchida (Japan, 2003)^Citation15	46/F	Distal pancreatectomy	Asymptomatic	Ultrasonography, angiography	Splenectomy
Köklü (Turkey, 2004)^Citation16	26/F	Renal abscess	GIB, abdominal pain, fever, dyspnea	Ultrasonography, CECT	Splenectomy, nephrectomy
Joya Seijo (Spain, 2004)^Citation17	46/NA	Renal-cell carcinoma	GIB	CECT	Splenectomy
Bilski (Poland, 2004)^Citation18	61/F	Chronic pancreatitis	NA	NA	Splenectomy
Yamaguchi (Japan, 2005)^Citation19	53/M	Pancreatic neuroendocrine tumor	GIB	CECT	Splenectomy, distal pancreatectomy, partial resection of gastric fundus, lymph node dissection
Hiraiwa (Japan, 2006)^Citation20	49/F	Colon cancer	Abdominal pain	CECT	Splenectomy, hemicolectomy, distal pancreatectomy
Liu (China, 2006)^Citation21	42/M	Embolization of varices	Fever	Ultrasonography, CECT	Antibiotic
Hariharan (UK, 2006)^Citation22	64/M	Trauma	GIB	CECT	Refused any treatment
Allen (USA, 2007)^Citation23	49/F	Chronic pancreatitis	GIB	Angiography	Splenic artery embolization
Guler (Turkey, 2008)^Citation24	23/F	MTHFR C677T mutation	Abdominal pain	Ultrasonography	Low-molecular weight heparin, splenectomy, warfarin
Tzur (Israel, 2008)^Citation25	46/M	Trauma, hyperhomocysteinemia	Chest pain	Magnetic resonance venography	Low-molecular weight heparin
Numora (Japan, 2009)^Citation26	39/F	Idiopathic	Abdominal pain	Autopsy	Transfusion without reporting other treatments
Karagiannis (Greece, 2012)^Citation27	70/F	Autoimmune hemolytic anemia	Abdominal pain, vomiting, nausea, constipation	CECT	Splenectomy
Chen (China, 2013)^Citation28	77/F	Lymphoma	GIB	CECT	Chemotherapy
Jain (India, 2014)^Citation29	16/F	Tuberculosis	Fever, dry cough, jaundice, vomiting	CECT	Low-molecular weight heparin, antituberculous
Köksal (Turkey, 2014)^Citation30	54/M	External compression	Fatigue, weight loss	CECT	Chemotherapy
Kiani (Iran, 2015)^Citation31	8/M	Idiopathic	GIB	CECT	Splenectomy
Parekh (USA, 2015)^Citation32	47/M	Lymphoma	GIB, lightheadedness, dyspnea, weakness	CECT	Splenectomy, chemotherapy
Lenhart (USA, 2016)^Citation33	73/M	Lymphoma	GIB	MRI	Splenic artery embolization
Franco-Avilés (Spain, 2017)^Citation34	31/M	Pancreatic pseudocyst	GIB	Angiography	Splenectomy
Lupascu-Ursulescu (Romania, 2017)^Citation35	37/F	Pancreatic cyst	GIB	Ultrasonography, CECT	Splenectomy, pancreatectomy
Salazar-Mejía (Mexico, 2017)^Citation36	26/M	Testicular cancer	GIB	CECT	Chemotherapy
Patel (USA, 2019)^Citation37	65/M	Essential thrombocytosis	GIB	Splenic venogram	Splenic artery embolization
Hayashi (Japan, 2020)^Citation38	70/M	Idiopathic	Epigastric discomfort	CECT	Splenectomy
Park (Korea, 2021)^Citation39	23/F	Pancreatic desmoid type fibromatosis	Abdominal pain	CECT, MRI	Splenectomy, distal pancreatectomy
Zafar (UK, 2022)^Citation5	64/M	Chronic pancreatitis	Chest pain	CECT	Heparin, apixaban
	71/M	Polycythemia rubra vera	Abdominal pain	CECT	Enoxaparin, rivaroxaban
Sikana (Indonesia, 2022)^Citation40	28/M	Liver cirrhosis, chronic pancreatitis	GIB Abdominal pain Ascites	CECT	Proton pump inhibitors, diuretics, octreotide, antibiotic
Capraro (USA, 2022)^Citation41	13/F	Acute pancreatitis	Abdominal pain	CECT	Low-molecular weight heparin, rivaroxaban
Füssel (Austria, 2023)^Citation42	45/F	Chronic pancreatitis	GIB	Angiography	Balloon dilatation and stenting
Pak (Korea, 2023)^Citation43	69/M	NA	GIB	CECT, angiography	Splenectomy
	57/M	Chronic pancreatitis	GIB	CECT, angiography	Splenic artery embolization
García Soria (Spain, 2023)^Citation44	42/M	Pancreatic neuroendocrine tumor	GIB	CECT, endoscopic ultrasonography	Anticoagulation, splenectomy

Abbreviations: GIB, gastrointestinal bleeding; CECT, contrast-enhanced computed tomography; MRI, magnetic resonance imaging; NA, not available.

Sutton JP, Yarborough DY, Richards JT. Isolated splenic vein occlusion. Review of literature and report of an additional case. Arch Surg. 1970;100(5):623–626. doi:10.1001/archsurg.1970.01340230089024

 PubMedGoogle Scholar

Khan AH, O’Reilly CJ, Avakian VA, Lucina PA. Splenic vein thrombosis: an unusual case of gastric bleeding. Angiology. 1977;28(10):725–727. doi:10.1177/000331977702801010

 PubMed Web of Science ®Google Scholar

Bunt TJ, Hackler MT, Greene FL. Isolated splenic vein thrombosis: the curable variceal hemorrhage. South Med J. 1983;76(7):936–938. doi:10.1097/00007611-198307000-00036

 PubMed Web of Science ®Google Scholar

Roder OC. Splenic vein thrombosis with bleeding gastroesophageal varices. Reports of two splenectomized cases and review of the literature. Acta Chir Scand. 1984;150(3):265–268.

 PubMedGoogle Scholar

Madsen MS. Splenic vein obstruction: a cause of upper gastrointestinal bleeding. Acta Chir Scand. 1986;152:393–395.

 PubMedGoogle Scholar

Singh K, Zargar SA, Bhasin D, Malik AK, Nagi B, Bose SM. Isolated splenic vein thrombosis with natural shunt caused by jejunal tuberculosis. Trop Gastroenterol. 1990;11(1):39–43.

 PubMedGoogle Scholar

Perisic-Savic M, Colovic R, Milosavljevic T, Ivanovic L. Splenic vein thrombosis. Diagnosed with Doppler ultrasonography. Hepatogastroenterology. 1991;38(6):557–560.

 PubMedGoogle Scholar

Moller S, Bech K, Bendtsen F. Segmental ”portal hypertension”. A rare cause of severe tractable variceal bleeding. Ugeskr Laeger. 1997;159(17):2563–2565.

 PubMedGoogle Scholar

Tsuchida S, Ku Y, Fukumoto T, Tominaga M, Iwasaki T, Kuroda Y. Isolated gastric varices resulting from iatrogenic splenic vein occlusion: report of a case. Surg Today. 2003;33(7):542–544. doi:10.1007/s10595-002-2519-7

 PubMed Web of Science ®Google Scholar

Koklu S, Koksal A, Yolcu OF, et al. Isolated splenic vein thrombosis: an unusual cause and review of the literature. Can J Gastroenterol. 2004;18(3):173–174. doi:10.1155/2004/801576

 PubMed Web of Science ®Google Scholar

Joya Seijo MD, Del Valle Loarte P, Marco Martinez J, Herrera Merino N, Agud Aparicio JL. Sinistral portal hypertension with bleeding gastric varices as initial manifestation of renal-cell carcinoma. An Med Interna. 2004;21(6):283–284. doi:10.4321/s0212-71992004000600006

 PubMedGoogle Scholar

Bilski RA, Szczepanik AB. Isolated splenic vein thrombosis. Wiad Lek. 2004;57(11–12):697–698.

 PubMedGoogle Scholar

Yamaguchi T, Takahashi H, Kagawa R, et al. Nonfunctioning pancreatic endocrine tumor presenting with hemorrhage from isolated gastric varices. Am Surg. 2005;71(12):1027–1030. doi:10.1177/000313480507101208

 PubMed Web of Science ®Google Scholar

Hiraiwa K, Morozumi K, Miyazaki H, et al. Isolated splenic vein thrombosis secondary to splenic metastasis: a case report. World J Gastroenterol. 2006;12(40):6561–6563. doi:10.3748/wjg.v12.i40.6561

 PubMed Web of Science ®Google Scholar

Liu CH, Tsai FC, Liang PC, Lee CZ, Yang PM. Splenic vein thrombosis and Klebsiella pneumoniae septicemia after endoscopic gastric variceal obturation therapy with N-butyl-2-cyanoacrylate. Gastrointest Endosc. 2006;63(2):336–338. doi:10.1016/j.gie.2005.08.025

 PubMed Web of Science ®Google Scholar

Hariharan D, Singhal R, Kinra S, Chilton A. Post traumatic intra thoracic spleen presenting with upper GI bleed!--a case report. BMC Gastroenterol. 2006;6(1):38. doi:10.1186/1471-230X-6-38

 PubMedGoogle Scholar

Allen LM, Behrens G, Patel NH, Ferral H. Splenic artery embolization and balloon occlusion retrograde alcohol embolization in a patient with bleeding gastric varices. Semin Intervent Radiol. 2007;24(1):53–57. doi:10.1055/s-2007-971186

 PubMedGoogle Scholar

Guler N, Yapici O, Erdem D, Ogur G, Ozatli D, Bakir T. Acute complete splenic infarction in a patient with Hirschsprung’s disease and literature review of complete splenic infarction. Pathophysiol Haemost Thromb. 2008;36(2):102–104. doi:10.1159/000173730

 PubMedGoogle Scholar

Tzur I, Almoznino-Sarafian D, Dotan E, et al. Splenic vein thrombosis following abdominal compression and vibration: a case report. Angiology. 2008;59(4):514–516. doi:10.1177/0003319707305403

 PubMed Web of Science ®Google Scholar

Nomura T, Keira N, Urakabe Y, et al. Fatal splenic laceration in a young woman caused by idiopathic isolated splenic vein thrombosis. Intern Med. 2009;48(11):907–910. doi:10.2169/internalmedicine.48.1843

 PubMed Web of Science ®Google Scholar

Karagiannis G, Anagnostara A, Samaras V, Mylona S. Isolated splenic vein thrombosis. JBR-BTR. 2012;95(2):105. doi:10.5334/jbr-btr.192

 PubMedGoogle Scholar

Chen BC, Wang HH, Lin YC, Shih YL, Chang WK, Hsieh TY. Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion. World J Gastroenterol. 2013;19(40):6939–6942. doi:10.3748/wjg.v19.i40.6939

 PubMed Web of Science ®Google Scholar

Jain D, Verma K, Jain P. Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses. Oxf Med Case Rep. 2014;2014(6):107–109. doi:10.1093/omcr/omu042

 PubMedGoogle Scholar

Koksal AS, Kalkan IH, Torun S, Yuksel M, Okten RS, Kayacetin E. Isolated splenic vein thrombosis and splenic infarct due to external compression of enlarged lymph nodes in a patient with lymphoma. Indian J Cancer. 2014;51(4):586. doi:10.4103/0019-509X.175293

 PubMed Web of Science ®Google Scholar

Kiani MA, Forouzan A, Masoumi K, et al. Isolated splenic vein thrombosis: 8-year-old boy with massive upper gastrointestinal bleeding and hypersplenism. Case Rep Pediatr. 2015;2015:480507. doi:10.1155/2015/480507

 PubMedGoogle Scholar

Parekh R, Walia S, Zalawadia A, Siddiqui Y. A rare case of splenic lymphoma in a patient with polymyositis manifesting as gastric variceal bleeding. Clin J Gastroenterol. 2015;8(2):92–96. doi:10.1007/s12328-015-0561-3

 PubMedGoogle Scholar

Lenhart A, Fernandez-Castillo J, Mullins K, Salgia R. A rare case of gastric variceal hemorrhage secondary to infiltrative B-cell lymphoma. Case Rep Gastroenterol. 2016;10(3):518–524. doi:10.1159/000445184

 PubMedGoogle Scholar

Franco-Aviles L, Hernandez-Rocha FI, Mercado U, Malvido-Torres CG. Segmental portal hypertension with splenic vein thrombosis caused by pancreatitis. Rev Med Inst Mex Seguro Soc. 2017;55(6):788–790.

 PubMedGoogle Scholar

Lupascu-Ursulescu C, Trofin AM, Zabara M, et al. Bleeding from isolated gastric varices as complication of a mucinous cystic neoplasm of the pancreas: a case report. Medicine. 2017;96(47):e8775. doi:10.1097/MD.0000000000008775

 PubMed Web of Science ®Google Scholar

Salazar-Mejia CE, Hernandez-Barajas D, Llerena-Hernandez E, et al. Testicular cancer presenting as gastric variceal hemorrhage. Case Rep Gastrointest Med. 2017;2017:4510387. doi:10.1155/2017/4510387

 PubMedGoogle Scholar

Patel H, Bhandari P, Kumar K, Makker J, Chandrala C. Isolated gastric varices due to essential thrombocytosis related to splenic vein thrombosis: a challenge to uncover the concealed diagnosis. Cureus. 2019;11(11):e6068. doi:10.7759/cureus.6068

 PubMed Web of Science ®Google Scholar

Hayashi H, Shimizu A, Motoyama H, et al. Left-sided portal hypertension caused by idiopathic splenic vein stenosis improved by splenectomy: a case report. Surg Case Rep. 2020;6(1):148. doi:10.1186/s40792-020-00912-y

 PubMed Web of Science ®Google Scholar

Park CG, Lee YN, Kim WY. Desmoid type fibromatosis of the distal pancreas: a case report. Ann Hepatobiliary Pancreat Surg. 2021;25(2):276–282. doi:10.14701/ahbps.2021.25.2.276

 PubMedGoogle Scholar

Zafar M, Heslop-Harrison W, Loterh L, Ofuafor K. Splenic vein thrombosis: a case series of consequential chronic pancreatitis and sequential myeloproliferative disorder. Cureus. 2022;14(6):e25924. doi:10.7759/cureus.25924

 PubMed Web of Science ®Google Scholar

Sikana AM, Thamrin H. Splenic vein thrombosis in cirrhosis of the liver: a rare case. Ann Med Surg. 2022;81:104439. doi:10.1016/j.amsu.2022.104439

 PubMed Web of Science ®Google Scholar

Capraro S, Acquazzino M, Drake M, Dike CR. Successful treatment of splenic vein thrombosis secondary to acute pancreatitis with oral anticoagulants: a pediatric case series. Am J Case Rep. 2022;23:e937599. doi:10.12659/AJCR.937599

 PubMedGoogle Scholar

Fussel LM, Muller-Wille R, Dinkhauser P, Schauer W, Hofer H. Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: a case report and literature review. World J Gastroenterol. 2023;29(24):3922–3931. doi:10.3748/wjg.v29.i24.3922

 PubMed Web of Science ®Google Scholar

Pak J, Lee S, Lee HN, Hyun D, Park SJ, Cho Y. Isolated gastric varix bleeding caused by splenic vein obstruction: two case reports. J Korean Soc Radiol. 2023;84(1):291–297. doi:10.3348/jksr.2022.0059

 PubMedGoogle Scholar

Garcia Soria A, Brotons Brotons A, Girona Torres E, et al. Gastric variceal bleeding as a form of presentation of pancreatic neuroendocrine tumor. Rev Esp Enferm Dig. 2023. doi:10.17235/reed.2023.9757/2023

 PubMed Web of Science ®Google Scholar