DDSEP® 8 Quick Quiz

October 2016 Quiz 2

Publish date: October 12, 2016

A 52-year-old woman with a history of both alcohol and IV drug abuse presents to the emergency department with hematemesis and melena. She was recently discharged from the hospital after an admission for severe acute pancreatitis and has been hospitalized multiple times with alcoholic pancreatitis. After resuscitation, she undergoes urgent endoscopy and is found to have a large gastric varix with a red wale sign, but no active bleeding. There are no esophageal varices.

What is the most likely underlying etiology of her presentation?

A. Alcoholic cirrhosis

B. Hepatitis C cirrhosis

C. Splenic vein thrombosis

D. Pancreatic cancer

E. Splenic artery pseudoaneurysm

Q2: Answer: C

Critique

Isolated gastric varices can be a complication of splenic vein thrombosis. The splenic vein courses superior to the pancreas from the splenic hilum to the main portal vein. Recurrent (or severe acute) inflammation of the pancreas can lead to splenic vein thrombosis, which can cause gastric varices due to backup of blood flow into the short gastric veins. The incidence of gastric varices in those with splenic vein thrombosis ranges from 15% to 55%.

Diagnosis can be made with a CT of the abdomen with contrast, and definitive treatment is splenectomy. Bleeding from a splenic artery pseudoaneurysm can also occur after pancreatitis (hemosuccus pancreaticus), and causes hemodynanically significant bleeding into the peritoneum or the bowel lumen via the pancreatic duct. However, it does not result in gastric varices.

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October 2016 Quiz 1