A case of isolated gastric varix caused by splenic vein occlusion after spleen preserving distal pancreatectomy

Abstract

A 70-year-old man was given a diagnosis of liver dysfunction by routine blood tests at a regional hospital. He was referred to our hospital in September 2008. Evaluation was consistent with an intraductal papillary-mucinous neoplasm of the pancreas (main pancreatic duct type). Spleen-preserving distal pancreatectomy (SPDP) with preservation of the splenic artery and vein was performed in June 2009. On postoperative day 25, postoperative bleeding from the drain suddenly occurred, which was caused by a ruptured aneurysm of the gastroduodenal artery (GDA), and related to a postoperative pancreatic fistula. Interventional radiology and arterial embolization was performed to control the bleeding from the aneurysm. After radiologic intervention, the postoperative course was uneventful and he was discharged on postoperative day 66. In November 2009 (5 months postoperatively), abdominal computed tomography showed occlusion of the splenic vein and a gastric varix. Upper gastrointestinal endoscopy also showed an isolated varix at the fornix of the stomach (Lg-cf, F2, Cb, RC sign (-)). We report a case of an isolated gastric varix caused by splenic vein occlusion after SPDP. © 2013 The Japanese Society of Gastroenterological Surgery.