A sinister source of gastrointestinal bleeding treated by transhepatic splenic varix embolization in a paediatric patient: a case report
Bibliographic record
Abstract
Background: Sinistral portal hypertension (SPH) is a rare complication of pancreatic disease. It can lead to splenic varices and variceal bleeding. It is described more commonly in adult populations but has rarely been described in relation to paediatric pancreatic pathologies. To date, only 3 reports of this phenomenon exist in the literature pertaining to a pediatric patient. The diagnosis is based on clinical symptoms and the absence of liver pathology and portal hypertension. There is no consensus for the treatment of this condition though splenectomy and embolization of the varices have been reported. The lack of published cases of paediatric patients with this condition and their subsequent medical or surgical therapy highlights the importance of contributing to the medical literature. Case Description: This case report details the clinical course of male paediatric patient with SPH as a complication of hereditary pancreatitis. He experienced many years of occult gastrointestinal bleeding (GIB), with a cause not identified on multiple imaging studies, nuclear medicine scans, gastrointestinal endoscopies and exploratory laparotomies. He was found to have splenic varices secondary to SPH. He had a proposed treatment of splenic vein thrombosis with embolization of the splenic vein and currently remains on medical therapy with nadolol without further bleeding episodes. Conclusions: Treatment avenues for sinistral portal hypertension remain controversial. In the past splenectomy was offered to most patients, especially those with significant thrombocytopenia or symptomatic disease, and is curative. At present less-invasive procedures such as splenic vein embolization or placement of coils are preferred and are in clinically stable patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".