Splenic vein thrombosis (SVT) is a condition that is largely precipitated by both the acute and chronic forms of pancreatitis [1] [2]. Pancreatitis is responsible for about 60% of cases of SVT, although the latter does not usually transpire during an acute attack, but rather after repeated insult. Patients with a history of pancreatitis have up to a 20% risk of developing SVT [3]. There are other conditions that contribute to the development of SVT to a lesser extent, and these include pancreatic pseudocysts, malignancies, peptic ulcer disease, liver cirrhosis, Mallory-Weiss tears and pancreatic surgery [4] [5]. Pancreatitis can precipitate SVT because of the close association of the tail of the pancreas with the splenic vein. Any inflammation that occurs in the pancreas inflicts damage on the splenic vein wall, leaving it susceptible to thrombus formation [1]. The splenic wall may also be compressed and thus partially occluded by adjacent enlarged lymph nodes.

SVT leads to sinistral portal hypertension, which in turn leads to gastric and esophageal varices. Many individuals with SVT present with gastrointestinal bleeding from varices, which can be life threatening. Nevertheless, most patients with SVT are asymptomatic. SVT should be considered in patients who present with splenomegaly, but no signs of hepatic, hematologic or portal pathology.

The pathophysiology of SVT, sometimes referred to as pancreatitis-induced SVT when it is secondary to pancreatitis, as well as subsequent GI bleeding, is not understood clearly.

• Infertility

  On the other hand, embolotherapy has a great spectrum of clinical applications such as the following: (i) trauma, (ii) tumors, (iii) infertility among men, (iv) impotence, and (v) vascular malformations [ 6 ]. [jmedicalcasereports.com]

• Splenomegaly

  Seven of 9 patients (78 %) with massive splenomegaly ( 20 cm) developed PSVT compared with 4 of 13 patients (31 %) with moderate splenomegaly (15-20 cm) and 6 of 45 patients (13 %) without (p CONCLUSION: In patients scheduled for LS, screening for prothrombotic [ncbi.nlm.nih.gov]

  SVT should be considered in patients who present with splenomegaly, but no signs of hepatic, hematologic or portal pathology. [symptoma.com]

• Massive Splenomegaly

  Routine ultrasound examination in the fourth month of the pregnancy revealed massive splenomegaly of unknown origin. Doppler ultrasonography subsequently revealed splenic venous thrombosis with absence of blood flow. [ncbi.nlm.nih.gov]

  Other causes Increased hepatic blood flow: Increased splenic blood flow - eg, massive splenomegaly. Hepatoportal arteriovenous fistula. Idiopathic (a diagnosis of exclusion). Left-sided (sinistral) portal hypertension Rare. [patient.info]

• Abdominal Pain

  Splenic vein thrombosis is an uncommon cause of abdominal pain, but one that should be included in the treating physician's differential diagnoses when abdominal pain is ongoing despite medical therapy. [ncbi.nlm.nih.gov]

  Abstract Abstract 4775 Abdominal pain is a common complaint among all ages of patients. [bloodjournal.org]

• Epigastric Pain

  We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. [ncbi.nlm.nih.gov]

  Case 4, a 45-year-old male with acute pancreatitis, presented with epigastric pain. CT showed splenic vein thrombosis, and the patient was treated with Coumadin. [bloodjournal.org]

  He was presented to the hospital due to his upper respiratory symptoms complaints and noted mild-to-moderate epigastric pain. Results of chest radiography and electrocardiography showed... [connection.ebscohost.com]

• Epigastric Pain

  We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. [ncbi.nlm.nih.gov]

  Case 4, a 45-year-old male with acute pancreatitis, presented with epigastric pain. CT showed splenic vein thrombosis, and the patient was treated with Coumadin. [bloodjournal.org]

  He was presented to the hospital due to his upper respiratory symptoms complaints and noted mild-to-moderate epigastric pain. Results of chest radiography and electrocardiography showed... [connection.ebscohost.com]

• Left Upper Quadrant Pain

  Case 1, a 45-year-old male with sickle cell trait (HbS of 38.7%), presented with left upper quadrant pain after 5-hour flight and alcohol binge prior to flight. CT showed splenic infarct and splenic vein thrombosis. [bloodjournal.org]

• Pancreatic Pain

  Surgical candidates are those who present with Symptomatic SVO and those with severe pancreatic pain who needs surgery for pancreatic procedures. [pancreas.imedpub.com]

• Yellow Discoloration of the Skin

  CASE REPORT We report a case of 16-year-old female who presented to our outpatient clinic with complaints of low-grade fever, dry cough, along with yellow discoloration of urine, skin and repeated episodes of vomiting of 7 days duration. [oxfordjournals.org]

• Sleep Disturbance

  Symptom evaluation includes fatigue, nausea and vomiting, pain, loss of appetite, dyspnea, sleep disturbance, constipation, diarrhea, and financial strain. [ncbi.nlm.nih.gov]

• Oliguria

  The authors present the case of a 17 year old girl admitted to hospital for poor general state, mild scleral jaundice, deficient nutritional state, oliguria and massive ascites. [ncbi.nlm.nih.gov]

There are several diagnostic modalities for splenic vein thrombosis available to clinicians. These include:

Invasive techniques

• Celiac angiography (late-phase): This is the preferred technique for detecting SVT, especially in the presence of GI bleeding.
• Splenoportography.
• Esophagogastroduodenoscopy (EGD): An endoscopic technique to diagnose varices. Its sensitivity varies because it is user dependent [6] [7].

Non-invasive techniques: These are increasingly instrumental in the diagnosis of SVT and pancreatitis, as their efficacy has improved.

• Ultrasound
• Computerized tomography: This is routinely carried out with contrast. It can also be useful as a screening tool [6] [8].
• Magnetic resonance imaging (MRI)

A dated diagnostic technique was post mortem analysis.

Patients should be evaluated for GI bleeding, specifically esophageal and gastric varices. The isolated presence of gastric varices, in the absence of esophageal counterparts, is highly suggestive of SVT. About half of individuals with splenic vein thrombosis present with splenomegaly. This is helpful in diagnosis, but its absence does not rule out the possibility of SVT [2]. Given the ambivalence of signs and symptoms in SVT, its diagnosis relies heavily on medical imaging.

• Gastric Varices

  OBJECTIVE: To determine the natural history of pancreatitis-induced splenic vein thrombosis with particular attention to the risk of gastric variceal hemorrhage. [ncbi.nlm.nih.gov]

• Left Pleural Effusion

  A chest radiograph revealed left pleural effusion and computed tomography scan for ruling out subsplenic abscess was negative. On the seventh postoperative day, her platelet count rose to 9,900,000, and aspirin (80 mg, four times a day) was added. [scielo.br]

• Nephrolithiasis

  Case Presentation A 60-year-old-male with past medical history of hypertension, hyperlipidemia, and nephrolithiasis presented with acute onset of hematemesis. He denied history of non-steroidal, anti-inflammatory drugs or alcohol use. [cureus.com]

• Gastric Lesion

  We report a case of chronic anemia due to portal hypertensive gastropathy in a patient with splenic vein thrombosis, and suggest that the cure of gastric lesions in this condition may be obtained by splenectomy. [ncbi.nlm.nih.gov]

1. Bernades P, Baetz A, Lévy P, Belghiti J, Menu Y, Fékété F. Splenic portal venous obstruction in chronic pancreatitis. Dig Dis Sci.1992;37(3):340-346.
2. Koklu SE, Yuksel OS, Arhan ME, et al. Report of 24 left-sided portal hypertension cases: a single-centre prospective study. Dig Dis Sci. 2005;50(5):976–982.
3. Heider TR, Azeem S, Galanko JA, Behrns KE. The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg. 2004;239(6):876–880; discussion 880-882.
4. Gianotti R, Charles H, Hymes K, Chandarana H, Sigal S. Treatment of gastric varices with partial splenic embolization in a patient with portal vein thrombosis and a myeloproliferative disorder. World J Gastroenterol. 2014;20(39):14495–14499.
5. Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol. 2010;8(2):200–205.
6. Mortelé KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features. J Comput Assist Tomogr. 2001;25(1):50–54.
7. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastro-oesophageal varices and variceal haemorrhage in cirrhosis. Hepatology. 2007;46(3):922-38.
8. Perri RE, Chiorean MV, Fidler JL, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for oesophageal varices. Hepatology. 2008;47(5):1587-1594.