[Segmental portal hypertension with splenic vein thrombosis caused by pancreatitis]

Splenic vein thrombosis is a complication of pancreatic carcinoma, pancreatitis or pancreatic pseudocyst. It may lead to segmental portal hypertension and bleeding from gastric varices.

A 31 year-old man was diagnosed with pancreatitis of two weeks of evolution and was referred to our hospital in 2013. He had a history of alcohol consumption. Physical examination showed no stigmata of liver cirrhosis. Laboratory analyses revealed hemoglobin 9.5 g/dL, and leukocytes and platelets were normal. Liver function tests were normal as well. Abdominal CT showed a pseudocyst, which was drained by percutaneous puncture. By pseudocyst recurrence, drainage and necrosectomy by retroperitoneal laparascopy were performed. The patient presented hyperglycemia during his treatment in hospital. He was discharged, but he returned to emergency room because of gastrointestinal bleeding without hemodynamic instability. Gastroscopy showed bleeding gastric varices. The colonoscopy showed normal results. Liver biopsy was also normal. Abdominal CT angiography revealed blockage of the splenic vein. Patient underwent splenectomy and was discharged.

This case is rare due to the high frequency of portal hypertension and cirrhosis. The isolated gastric varices with normal liver function are a sign of splenic thrombosis. The definitive treatment is splenectomy.