Idiopathic splenic vein stenosis with splenic infarction: a case report of rare non-bleeding cause of left-sided portal hypertension.

BACKGROUND

Idiopathic splenic vein stenosis is a rare cause of left-sided portal hypertension, typically presenting with gastric varices and bleeding risk. Non-hemorrhagic presentations including those associated with splenic infarction, have not been reported. CASE PRESENTATION: A 71-year-old woman presented with persistent epigastric discomfort. Endoscopy revealed type I isolated gastric fundal varices, and contrast-enhanced Computer tomography confirmed high-grade splenic vein stenosis, collateral vessels, a wedge-shaped splenic infarction, moderate splenomegaly, and incidental celiac trunk and superior mesenteric artery stenoses. Laparoscopic splenectomy was performed due to symptomatic infarction and bleeding risk, resolving discomfort. Postoperative follow-up revealed portal vein thrombosis with cavernous transformation, managed with anticoagulation. Gastroscopic follow-ups post-splenectomy showed near-complete variceal resolution and no esophageal varices.

CONCLUSION

This case highlights a rare non-bleeding presentation of idiopathic splenic vein stenosis with splenic infarction, the diagnostic utility of advanced imaging, and the role of splenectomy for symptom and variceal resolution. Postoperative portal vein thrombosis suggests a possible underlying vasculopathy, warranting vigilant surveillance and further study.