Sinistral portal hypertension

Last revised by Vikas Shah on 18 Dec 2019

Sinistral portal hypertension (also known as left-sided portal hypertension or segmental portal hypertension) is an uncommon form of portal hypertension.

Clinical presentation

Sinistral portal hypertension is most commonly found incidentally in asymptomatic patients. In symptomatic patients, the most common presentation (although rare) is gastrointestinal bleeding from esophageal or gastric varices 2.

Splenomegaly is common (~70%). Cirrhosis and ascites are not common presenting features 4

Pathology

Sinistral portal hypertension results from occlusion of the splenic vein, usually from pancreatic pathology (e.g. pseudocyst, carcinoma). 

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