Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis.

Eleven of 16 patients with splenic vein thrombosis subsequent to pancreatitis had variceal hemorrhage. variceal development tends to occur in the stomach, although esophageal varices may also occur, and is a result of left-sided or segmental portal hypertension. The antecedent pancreatitis may be quite mild and produce minimal symptoms. Angiography is required to establish the diagnosis as endoscopic detection of gastric varices is difficult and unreliable. Splenectomy is the definitive treatment, although transgastric ligation of varices must be added if active bleeding is taking place.