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From question on page 104
The endoscopy image (fig 1) demonstrates florid duodenal varices. Figure 2 shows an atrophic calcified pancreas in keeping with a history of acute pancreatitis complicated by pseudocyst formation and subsequent chronic pancreatitis. Figure 3 illustrates splenic vein thrombosis at the splenic hilum along with extensive duodenal varices. Surprisingly, gastric varices were not demonstrated. The patient continued to be transfusion dependent and haemodynamically unstable and was transferred to the regional liver unit for a splenectomy. He remains well at follow up.
Splenic vein thrombosis complicates acute pancreatitis in up to 19% of cases.1 Other causes include pancreatic adenocarcinoma, pancreatic cysts, or pseudocysts. Rarely it may also be caused by hypercoaguable states, including nephrotic syndrome and sickle cell anaemia. Pathophysiologically, splenic blood is shunted into the portal circulation through the short gastric vessels, resulting in the formation of gastric and duodenal varices. Oesophageal varices are uncommon in this situation because the collateral circulation does not involve the oesophagus. Variceal bleeding occurs in only 4% of patients with splenic vein thrombosis and treatment consists of either a splenectomy or splenic artery embolisation.2 Patient outcome depends on the aetiology of the splenic vein thrombosis.