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  • • Upper GI hemorrhage with evidence of gastric varices without esophageal varices

    • History of pancreatic or gastric disease

    • Splenectomy is curative

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Epidemiology

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  • • Isolated thrombosis in the splenic vein, diverting the splenic venous outflow to the short gastric vessels as collaterals

    • Increased pressure in the short gastric (left-sided or sinistral portal hypertension) veins causes dilation of the submucosal venous plexus in the gastric cardia and fundus, leading to gastric varices

    • 50% of cases due to pancreatitis or pancreatic pseudocyst

    • Pancreatic cancer with splenic vein invasion is the second most common cause

    • Penetrating posterior gastric ulcer and retroperitoneal fibrosis are less common causes

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Symptoms and Signs

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  • • Upper GI hemorrhage

    • Splenomegaly may be present

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Laboratory Findings

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  • • Anemia if bleeding is present

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Imaging Findings

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  • Gastroscopy: Bleeding from isolated gastric varices, without evidence of esophageal varices

    Conventional or magnetic resonance angiography: Absence of flow through splenic vein, with collateralization through the short gastric veins

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  • • Splenic vein thrombosis should be suspected in any patient with upper GI hemorrhage and isolated gastric, without esophageal varices at endoscopy

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Rule Out

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  • • Portal hypertension

    • Other sources of upper GI bleeding

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  • • Upper GI endoscopy

    • Conventional or magnetic resonance angiography (if indicated to make a definitive diagnosis)

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When to Admit

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  • • Active bleeding

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Surgery

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  • • Splenectomy is curative

    • Even if the patient is asymptomatic and has not experienced an upper GI bleed, splenectomy should be performed electively

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Indications

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  • • All cases

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Complications

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  • • Upper GI bleeding

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Prognosis

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  • • Splenectomy is curative

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References

Agarwal AK et al: Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg 2008;196:149.  [PubMed: 18585674]

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