LAUSR

Bleeding from gastric fundal varices (GFVs) is generally less frequent but more severe than bleeding from esophageal varices [1], and currently a gold standard treatment does not yet exist. The presence of GFVs without esophageal varices could be a sign of splenic vein occlusion because blood drainage is diverted by the coronary vein into the portal system within a framework of so-called left-sided portal hypertension (LSPH) [2]. Often LSPH may be due to iatrogenic splenic vein injury or ligation [3]. The importance of differentiating between left-sided and generalized portal hypertension lies in the distinct therapeutic management of each disease process. In the patient described here, since it proved impossible to achieve a safe and effective embolization throughout a previously placed TIPS that did not allow gastric veins (GVs) decompression, a percutaneous trans-splenic embolization (PTSE) of GFVs and two partial splenic embolizations (PSEs) were performed with the aim to reduce the splenic venous outflow. Case Report