Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 ++Agarwal AK et al: Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg 2008;196:149. [PubMed: 18585674] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth