Portal hypertension is commonly associated with splenomegaly and, at times, with functional hypersplenism and its attendant peripheral blood cytopenias. Splenectomy has been the most frequently used procedure for hypersplenism, but it is associated with a 30-day mortality rate that approaches 20% [1]. In patients with underlying cirrhosis, infections developing after splenectomy are also a prominent problem [2, 3]. Other surgical procedures, such as splenic artery ligation or portosystemic shunting, produce limited clinical improvement.

We report a case of successful percutaneous transcatheter arterial embolization for treatment of a patient with hypersplenism associated with cirrhosis and hepatocellular carcinoma. A 54-year-old nonalcoholic Arabic man who had had idiopathic thrombocytopenic purpura for 4 years was evaluated for a 2-week history of right upper-quadrant pain. Physical examination, a computed tomographic scan of the abdomen, and a subsequent biopsy specimen showed multicentric hepatocellular carcinoma. Initial laboratory studies showed a platelet count of 32000 cells/mm³, a leukocyte count of 5400 cells/mm³, and a hemoglobin level of 13.5 g/dL; results of serum biochemical studies were within normal limits except for an elevated serum alanine amino-transferase level (108 IU/L; normal, 7 to 56 IU/L). No platelet-specific antibodies were seen. The patient had serologic reactivity to hepatitis B and C viruses but not to human immunodeficiency virus type 1 or 2. A bone marrow biopsy specimen showed normal elements and 60% cellularity. Hepatocellular carcinoma was treated with chemoembolization with cisplatin, doxorubicin, mitomycin C, and polyvinyl alcohol foam, followed by systemic 5-fluorouracil and recombinant human interferon-. During the next 18 months, the thrombocytopenia became resistant to intravenous immunoglobulins, and the patient developed persistent neutropenia when not receiving therapy. The patient had three splenic embolizations with Gelfoam particles and cefoperazone through a right femoral arterial approach over 4 weeks, and his platelet count increased to more than 190000 cells/mm³ without further therapy.

Splenic embolization with subtotal infarction is usually well tolerated and represents a potential alternative for patients with hypersplenism secondary to portal hypertension who may not be surgical candidates [4, 5].