Splenic vein thrombosis in patients with a normal size spleen

The frequency of splenic vein obstruction secondary to pancreatic or retroperitoneal diseases has been only recently appreciated. The diagnosis is important because it frequently results in development of gastric and duodenal varices. It is often assumed that the diagnosis should only be suspected in patients with splenomegaly. This report describes 19 patients in whom splenic vein thrombosis was diagnosed by angiography although clinically unsuspected. In 11, the spleen was normal in size although extensive gastric varices were present. In 3 patients the presenting problem was massive hematemesis. Review of the upper gastrointestinal examinations in these patients showed thickened gastric or duodenal folds although in the absence of esophageal varices, the diagnosis was not made prior to angiography. More liberal use of angiography in patients with an appropriate clinical background, such as a history of pancreatitis, may lead to earlier and more frequent diagnosis of splenic vein obstruction. Varices that result from splenic vein obstruction can be cured by splenectomy.