PMC5498196_01
Abdominal computed tomography (CT). (A) CT before hepatic resection for hepatocellular carcinoma. (B) CT before partial splenic arterial embolization.
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In 1995, a 53-year-old male patient with chronic hepatitis B received left lobectomy for a 12-cm hepatocellular carcinoma (HCC) in the left lobe of the liver (Fig. 1A).
Images of esophago-gastro-duodenoscopy (EGD) and endoscopic ultrasonography (EUS) before partial splenic arterial embolization. (A) An EGD image of the gastric variceal bleeding. (B) EUS. Arrows, gastric varices.
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EGD revealed a large amount of fresh blood in his stomach, but the source of the bleeding was unclear (Fig. 2A). Endoscopic ultrasonography (EUS) was performed and gastric varices were detected as vessel-like echoic-free spaces, 2 mm in diameter, in the fornix of the stomach (Fig. 2B). EIS was performed by injecting 5% EO directly into the varices. The ruptured gastric varices in this patient were very small and difficult to distinguish from gastric folds. The varices were identified only by EUS (Fig. 2B).
Angiography. (A) image of arterial phase before partial splenic embolization (PSE). (B) image of late phase before PSE. (C) image of arterial phase after PSE.
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The celiac arteriogram showed massive splenomegaly with a cephalocaudal length of 23.5 cm (Fig. 3A, B). The catheter was placed in the splenic artery and embolization was performed using a 2-mm-square gelatin sponge via the blood flow until the splenic arterial flow was completely stopped (Fig. 3C).
Abdominal computed tomography after partial splenic embolization. (A) Image at 7 days. (B) Image at 1 year. (C) Image at 5 years.
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Seven days after PSE, a massive infarcted area was observed in the spleen (Fig. 4A) with 70% of the total spleen volume analyzed by CT volumetry (Table 2).
Esophago-gastro-duodenoscopy (EGD) and endoscopic ultrasonography (EUS) 5 years after partial splenic embolization. (A) EGD. (B) EUS. Arrows, treated gastric varices.
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Two years after PSE, EGD showed no sign of recurring gastroesophageal varices (Fig. 5).