Published Online : 2026-06-30
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.
Case Report
English
P. 97-100
