A Case Report on Splenic Artery Embolization for Refractory Gastro-Esophageal Variceal Hemorrhage in a Child

Gastro-esophageal variceal hemorrhage (GEVH) is a significant cause of severe gastrointestinal bleeding in children. Various treatment options, including medical, endoscopic, angiographic, and surgical methods, can be employed. This case report detailed the use of partial splenic artery embolization to manage refractory GEVH resulting from portal vein thrombosis.

A 3-year-old boy was admitted with abdominal swelling and had a history of hepatosplenomegaly for two years. He weighed 15.5 kg and measured 96 cm in height, both within the 50-75th percentile range. His general health was moderate, and he appeared pale.

A physical examination revealed his liver was enlarged by 2 cm, while his spleen was 6 cm below the rib cage. Laboratory tests showed hemoglobin at 7.1 g/dL and a platelet count of 67,000/mm³, among other findings. An abdominal CT angiography indicated a significant thrombus at the portal confluence. Endoscopic evaluation revealed prominent esophageal varices and signs of portal vein thrombosis. 

The patient began treatment with a proton pump inhibitor and a beta-blocker and underwent endoscopic band ligation three times over nine months. Despite this, he experienced GEVH three times during a year and a half of follow-up, prompting a decision to proceed with splenic artery embolization due to new varices. The interventional procedure focused on the lower splenic pole, and six months later, a second embolization was performed. The patient has since been monitored for three years without any further GEVH episodes.

This case demonstrates that splenic artery embolization is an efficient, safe, and repeatable treatment for patients suffering from hypersplenism due to portal hypertension and refractory esophageal variceal bleeding.

Source: Dinçer BT, Urgancı N, Bayrak AH et al. The role of partial splenic artery embolization in the management of refractory esophageal variceal bleeding due to portal vein thrombosis. BMC Pediatr.2025;25(49). https://doi.org/10.1186/s12887-025-05414-0