Background and Aims Patients with severe acute pancreatitis (SAP) have a critical and rapidly progressing condition with many complications. Among them, pancreatic portal hypertension (PPH) is a localized and regional portal hypertension. Some patients with PPH are well compensated and have no obvious clinical symptoms, and only spleen enlargement is found during examination, for whom only conservative internal medicine treatment and regular follow-up are needed. For patients with PPH-related symptoms, splenectomy is currently recommended. However, SAP patients combined with PPH generally have a poor overall condition, with greater inflammatory edema and abdominal infection, splenectomy may increase the risk of infection and bleeding. There is currently a lack of recommendations and consensus on treatment methods for such patients both domestically and abroad. Therefore, this study was performed mainly to investigate the clinical efficacy of partial splenic artery embolization (PSE) in the treatment of symptomatic SAP patients with concomitant PPH, as well as the indications, timing, and procedural methods for treatment.Methods The clinical data of 15 patients with SAP and concomitant PPH admitted to the Center for Severe Pancreatitis of Jinling Hospital Affiliated with Nanjing Medical University from January 2014 to December 2021 were retrospectively summarized. The clinical diagnosis and treatment process and prognosis of the patients undergoing PSE therapy for PPH were analyzed, and the relief of PPH clinical symptoms, results of laboratory blood routine tests and imaging examinations, postoperative complications, and recurrence of PPH symptoms of the patients were observed. Imaging evaluations were performed on 3 d as well as 1, 3, and 6 months after operation, and SF-36 quality of life scale scores were assessed before and 1 year after operation.Results All 15 patients received routine treatment including fluid infusion, anti-infection therapy, and enteral nutrition after admission. The median time from AP onset to PSE surgery varied greatly among the patients, with a median time of 487 d. Clinical symptoms related to PPH included splenomegaly and gastric variceal bleeding. Among the 15 patients, 5 had only splenomegaly, 8 had only variceal bleeding, and 2 had both above symptoms. The median area of splenic embolization was 60%. Of the 7 patients with splenomegaly, the peripheral blood cells in all cases recovered to varying degrees after operation, and the blood cell counts had basically returned to normal at 6 months of follow-up. The symptoms of hematemesis, melena and gastric varices were significantly relieved after operation in the 8 patients with repeat upper gastrointestinal bleeding. Two patients developed splenic abscess, which was treated with antibiotics and percutaneous splenic abscess puncture and drainage, and both patients recovered after treatment and were discharged after tube removal. During the 1-year follow-up period, all 15 patients survived without any recurrence of clinical symptoms or complications. The results of the SF-36 quality of life questionnaire showed that various aspects of the patients' quality of life had significantly improved one year after discharge compared to admission (all P<0.05). The three blood cell series of patients with splenomegaly recovered to normal levels, and patients with a history of gastrointestinal bleeding did not experience the symptoms of hematemesis or black stool again.Conclusion For patients with SAP and symptomatic PPH, PSE is a safe and effective treatment method under the premise of reasonable judgment of surgical indications and timing.