Splenic Vein Thrombosis

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

  • History of pancreatic or gastric disease

  • Splenectomy is curative

Epidemiology

• • 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

Symptoms and Signs

• • Upper GI hemorrhage

  • Splenomegaly may be present

Laboratory Findings

• • Anemia if bleeding is present

Imaging Findings

• • 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

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

Rule Out

• • Portal hypertension

  • Other sources of upper GI bleeding

• • Upper GI endoscopy

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

When to Admit

• • Active bleeding

Surgery

• • Splenectomy is curative

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

Indications

• • All cases

Complications

• • Upper GI bleeding

Prognosis

• • Splenectomy is curative

References