Melena as Initial Presentation of Adenocarcinoma in Pancreatic Tail

Melena associated with gastric varices, in the setting of possible obstructing pancreatic adenocarcinoma, has been poorly documented as an initial presenting sign for pancreatic malignancy. Considering the late presentation of patients with pancreatic malignancy, it is important to consider all potential presenting symptoms for the early detection and treatment of pancreatic malignancy. Below, we present a patient with no history of liver pathology, who presents with melena and gastric varices, likely relating to portal hypertension in the setting of an obstructing pancreatic malignancy.