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Indian Journal of Emergency Medicine 12(2):p 97-100, April-June 2026. | DOI: https://doi.org/10.21088/ijem.2395.311X.12226.7
Case Report
Beyond Cirrhosis: When Pancreas Bleed
Apurva Sahay, Kishalay Datta, Surjeet Acharya
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Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Indian Journal of Emergency Medicine 12(2):p 97-100, April-June 2026. | DOI: https://doi.org/10.21088/ijem.2395.311X.12226.7
How Cite This Article:
Apurva Sahay, Kishalay Datta, Surjeet Acharya. Beyond Cirrhosis: When Pancreas Bleed. Ind J Emerg Med. 2026; 12(2): 97-100Timeline
Received : January 23, 2026
Accepted : February 25, 2026
Published : June 30, 2026
Abstract
Pancreatic cancer is a highly aggressive malignancy with poor prognosis, largely due to its silent onset and delayed diagnosis. Patients typically present with vague symptoms such as abdominal discomfort, jaundice, anorexia, and weight loss. Uncommonly, pancreatic malignancy may initially manifest as upper gastrointestinal bleeding, a presentation that can obscure the underlying diagnosis. One rare but important mechanism for such bleeding is splenic vein thrombosis, which leads to left-sided portal hypertension and the development of isolated gastric varices. Unlike portal hypertension due to chronic liver disease, this condition spares the liver and oesophagus, making recognition challenging. In the emergency setting, patients presenting with melena or hematemesis in the absence of liver dysfunction, ascites, or abnormal liver function tests often prompt diagnostic uncertainty. Cross-sectional imaging with contrast-enhanced CT or MRI plays a crucial role in identifying splenic vein thrombosis and associated pancreatic pathology. Tumours involving the pancreatic tail are particularly prone to causing venous compression or invasion, resulting in thrombosis. Management differs from conventional variceal bleeding, as endoscopic therapy provides only temporary control. Definitive treatment requires addressing the underlying cause, often through distal pancreatectomy with splenectomy in resectable disease. This report highlights pancreatic cancer as a rare but critical cause of isolated gastric variceal bleeding and emphasizes the importance of maintaining a high index of suspicion to enable timely diagnosis and potentially curative intervention.
References
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Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
No conflicts of interest in this work.
About this article
Cite this article
Apurva Sahay, Kishalay Datta, Surjeet Acharya. Beyond Cirrhosis: When Pancreas Bleed. Ind J Emerg Med. 2026; 12(2): 97-100
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| January 23, 2026 | February 25, 2026 | June 30, 2026 |
DOI: https://doi.org/10.21088/ijem.2395.311X.12226.7
Keywords
CirrhosisPancreatic cancerGastric varicesVariceal bleedSearch for Similar Articles
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Timeline
| Received | January 23, 2026 |
| Accepted | February 25, 2026 |
| Published | June 30, 2026 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
