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Annals of Medicine and Medical Education
Volume 2, Issue 1 (March 2015), pp. 15-19

DOI: 10.12973/ejms.2015.136p

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Case Report

Published online on Mar 01, 2015

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Isolated Gastric Variceal Bleeding Due To Segmental Portal Hypertension Developed As A Consequence of Pancreatic Ductal Adenocarcinoma: A case report

Zülfü BAYHAN, Sezgin ZEREN, Süleyman COSGUN, Ayse Nur DEGER, Bercis Imge UCAR, Serdar UCGUN, Nilüfer ARAZ BAYHAN, Mehmet KORKMAZ, Sükrü Aydın DUZGUN

Abstract

Introduction: Isolated gastric varices may be seen in stomach without esophageal varices. They are mostly seen in patients with liver cirrhosis, but sometimes they can be caused by segmental portal hypertension. Segmental portal hypertension occurs due to pathologies that causes splenic vein occlusion, mostly because of pancreatic diseases.
Case report: A 54 year-old patient presented to the emergency department with hematemesis and melena. Patient was diagnosed with upper gastrointestinal bleeding and treated conservatively after hospitalization. Upper gastrointestinal tract endoscopy showed cardio-fundal gastric varices. Band ligation was applied to the fundal variceal bleeding focus. CT scan was primarily performed to investigate the etiology of isolated gastric varices after haemostasis was achieved. Contrast-enhanced CT scan showed a mass lesion which invaded caudal pancreas and spleen through the splenic hilum, and caused splenic vein occlusion. Thereupon operation was planned to excise the pancreatic tumor. Distal pancreatectomy and splenectomy was performed. No gross abnormality was observed during the postoperative follow-up. Histopathological examination was reported as infiltrative ductal adenocarcinoma. Therefore, patient was referred to the department of medical oncology to continue her treatment.
Conclusion: Upper gastrointestinal tract endoscopy has a very important role in diagnoses and treatment of bleeding isolated gastric varices. Segmental portal hypertension should be considered and underlying pathologies, especially pancreatic diseases, should be investigated in patients diagnosed with isolated gastric varices without any liver disease. If a resectable tumor of pancreas is the etiology of segmental portal hypertension, it has to be resected immediately.
Keywords: Isolated gastric varices, pancreatic mass, segmental portal hypertension, splenic vein occlusion, pancreatic ductal adenocarcinoma

 


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