Puzzles in practice: splenic vein thrombosis

Area of Science:

• Gastroenterology
• Oncology
• Radiology

Background:

• Splenic vein thrombosis (SVT) is an uncommon cause of abdominal pain.
• Pancreatic pathology is a frequent underlying cause of SVT.
• Persistent abdominal pain warrants a broad differential diagnosis.

Observation:

• A 58-year-old male presented with epigastric pain, dry heaving, and constipation.
• Initial diagnosis of gastritis was treated with escalating proton pump inhibitor doses.
• Computed tomography revealed splenic vein thrombosis with collateral vasculature, suggesting a chronic condition.

Findings:

• The patient was ultimately diagnosed with biopsy-proven pancreatic cancer.
• Splenic vein thrombosis was identified as the likely cause of the patient's chronic abdominal pain.
• Prominent collateral vasculature indicated the chronic nature of the splenic vein thrombosis.

Implications:

• This case underscores the need to investigate persistent abdominal pain unresponsive to acid-reducing agents.
• Physicians should consider SVT and pancreatic cancer in the differential diagnosis for unexplained abdominal pain.
• Red flag symptoms like decreased appetite and weight loss necessitate a thorough workup for abdominal pathology.