SINISTRAL PORTAL HYPERTENSION SECONDARY TO
RENAL CELL CARCINOMA: A CASE REPORT
A.Y. Pang Jr. MD; M.C. Naval MD; F.L. Domingo Jr. MD;
M.T. Te, MD; L.D. Gatchalian MD; M.A.V. Chu MD
Section of Gastroenterology, Department of Internal Medicine
East Avenue Medical Center, Quezon City Manila, Philippines
Significance: Left-sided portal hypertension is a rare clinical condition accounting to less than 5 percent of patients with portal hypertension. Splenic vessel compression and encasement from direct extension from a renal cell carcinoma is uncommon. We report a case of left sided portal hypertension from a patient with a renal cell carcinoma.
Clinical Presentation: We report a 34-year old Filipino woman presenting with recurrent hematemesis, melena and a non-tender left flank mass. On examination, she was clinically pale, tachycardic and normotensive. Imaging studies revealed a large left renal mass consistent with a malignancy with encasement of the splenic artery, splenomegaly and displacement of the pancreas, splenic vein, portal vein, celiac trunk, superior mesenteric artery and inferior vena cava.
Management: After correction of her anemia, she underwent esophagogastroduodenoscopy revealing an isolated gastric varices type 1 (IGV1). She underwent exploratory laparotomy, radical nephrectomy, splenectomy, wedge resection of gastric greater curvature, and distal pancreatectomy with lymph node dissection. Histopathology revealed a renal cell carcinoma with direct extension to the spleen, stomach and pancreas. She was subsequently discharged and was referred to oncology section for chemotherapy, but however refused treatment. Upon follow-up there was no recurrence of hematemesis or melena.
Recommendation: An isolated gastric varices in a young patient with no stigmata of liver disease warrants further work-up for the evaluation for a possible left sided portal hypertension particularly if an underlying malignancy is considered. Management is geared towards the cause of portal hypertension.
Keywords: Case report, varices, sinistral portal hypertension, renal cell carcinoma