Fig. 1: Axial CT image in a 44-year-old woman shows multiple dilated venous collaterals (varices) along the stomach (arrows).
Fig. 2: Axial CT image of the same patient shows a large pancreatic pseudocyst (stars) with absence of the splenic vein, indicating splenic vein thrombosis from chronic pancreatitis.
- Localized form of extrahepatic portal hypertension developed after splenic vein thrombosis/obstruction
- Formation of varices, with potential for massive upper GI bleeding
- Most common cause = chronic pancreatitis
- Incidence: 7% of patients with chronic pancreatitis
- Potentially curable by splenectomy
- Suspected in patients with bleeding esophageal varices, splenomegaly and normal liver function
- In many patients, splenic vein obstruction is silent and undetected
- Likely related to many factors: compression of the veins by chronic inflammation (i.e. pseudocyst), stasis, intimal injury related to recurrent pancreatitis, systemic hypercoagulable state
- Leads to obstruction of splenic venous outflow. Venous blood from spleen returns to the heart via low-pressure collaterals (short gastric/gastroepiploic veins). This can be seen as gastric varices, and in some cases - esophageal varices.