[Haematemesis due to splenic vein thrombosis].
BACKGROUND
Haematemesis due to gastric fundal varices as a result of splenic vein thrombosis is rare. Splenic vein thrombosis may occur after pancreatitis and can lead to left-sided portal hypertension. Venous drainage from the spleen then occurs through the short gastric vessels, resulting in gastric varices.


METHODS
Gastroscopy was performed in a 31-year-old man for transgastric drainage of fluid which had accumulated after an episode of acute pancreatitis. A gastric blood clot and fundal varices were observed. Three days later, the patient experienced haematemesis and went into a state of shock. Gastroscopy showed a bleeding fundal varix which was treated by an injection of Lipiodol/Histoacryl. CT confirmed thrombosis of the splenic vein. Six weeks later, splenectomy was performed and no subsequent bleeding occurred.


CONCLUSIONS
Haematemesis in patients with a history of chronic or acute pancreatitis can be a life-threatening expression of gastric fundal varices caused by splenic vein thrombosis. In cases of severe haemorrhaging, splenectomy is the treatment of choice.
Sint Antonius Ziekenhuis, Afd. Chirurgie, Nieuwegein, the Netherlands.
Young-Kon
YK
Lambeck
H L Erik
HL
van Westreenen
Bas L A M
BL
Weusten
Robin
R
Timmer
Djamila
D
Boerma
D000328:Adult; D005773:Gastroscopy; D006396:Hematemesis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D013154:Spleen / Q000098:blood supply* / Q000601:surgery; D013156:Splenectomy; D013162:Splenic Vein / Q000473:pathology*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery