{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:49:53Z","timestamp":1776689393784,"version":"3.51.2"},"reference-count":0,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2000,1,1]],"date-time":"2000-01-01T00:00:00Z","timestamp":946684800000},"content-version":"vor","delay-in-days":3652,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HPB Surgery"],"published-print":{"date-parts":[[1990,1]]},"abstract":"<jats:p>Although restricted transhepatic portal flow is necessary for development of generalized portal\nhypertension (GPH), increased splanchnic arterial inflow also contributes to GPH and its clinical\nsequelae. In this context, we describe 7 male and 6 female patients (mean age 48 years) in whom the\nlesser splanchnic (gastrosplenic) system played a key role in the signs and symptoms of GPH. These 13\npatients (9 with hepatic cirrhosis, 3 with primary myeloproliferative disorder, and 1 with extrahepatic\nportal block) shared common features of massive splenomegaly, huge splenofundic gastric varices, often\nwith a prominent natural shunt to the left renal vein. Total or near total splenectomy alone or combined\nwhere appropriate with coronary vein ligation was effective in controlling varix hemorrhage (10\npatients), ascites (3), or complications of an enlarged spleen\u2010anorexia and abdominal pain (3),\nhemolytic anemia (1) and profound thrombocytopenia with severe epistaxis (1). Intraoperative jejunal\nportal venography was crucial in operative management in order to establish definitively the presence or\nabsence of coronary venous collaterals, and when present, to verify their operative ligation.<\/jats:p><jats:p>These distinctive patients illustrate: 1) GPH is a heterogeneous syndrome of divergent splanchnic\ncirculatory patterns, a feature which should be taken into account in selecting operative treatment; 2)\none well\u2010defined subgroup displays prominent hyperdynamic lesser splanchnic and specifically, splenic\nblood flow as a major contributor to clinical complications; and 3) within this subgroup, splenectomy\ncombined with documented absence or surgical interruption of coronary venous collaterals as corroborated\nby intraoperative portography is effective alternative treatment.<\/jats:p>","DOI":"10.1155\/1990\/94864","type":"journal-article","created":{"date-parts":[[2007,9,13]],"date-time":"2007-09-13T09:19:26Z","timestamp":1189675166000},"page":"233-251","source":"Crossref","is-referenced-by-count":2,"title":["Preeminence of Lesser Splanchnic BloodFlow in Selected Patients WithGeneralized Portal Hypertension"],"prefix":"10.1155","volume":"2","author":[{"given":"Charles L.","family":"Witte","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlys H.","family":"Witte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald D.","family":"Pond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[1990,1]]},"container-title":["HPB Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/archive\/1990\/094864.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/1990\/94864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T02:47:53Z","timestamp":1723085273000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/1990\/94864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1990,1]]},"references-count":0,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1990,1]]}},"alternative-id":["10.1155\/1990\/94864"],"URL":"https:\/\/doi.org\/10.1155\/1990\/94864","archive":["Portico"],"relation":{},"ISSN":["0894-8569","1607-8462"],"issn-type":[{"value":"0894-8569","type":"print"},{"value":"1607-8462","type":"electronic"}],"subject":[],"published":{"date-parts":[[1990,1]]}}}