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

    • History of pancreatic or gastric disease

    • Splenectomy is curative


  • • 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


  • • Splenectomy is curative

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


  • • All cases


  • • Upper GI bleeding


  • • Splenectomy is curative


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

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