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Case Reports
. 2026 Jan 7;18(1):e100992.
doi: 10.7759/cureus.100992. eCollection 2026 Jan.

Isolated Gastric Variceal Bleeding: A Sentinel Sign of Pancreatic Neoplasm Manifesting as Sinistral Portal Hypertension

Sergio David Angulo  1 , Julian Toro  2 , Jesús Hinestroza  2 , Isabel Sánchez  3 , David Cataño  4 , Leisly T Oviedo Gomez  5
Affiliations
Case Reports

Isolated Gastric Variceal Bleeding: A Sentinel Sign of Pancreatic Neoplasm Manifesting as Sinistral Portal Hypertension

Sergio David Angulo et al. Cureus. .

Abstract

Sinistral portal hypertension (SPH) is an uncommon condition secondary to stenosis of the splenic vein. The most common causes are chronic pancreatitis and pancreatic cancer. This localized hypertension can lead to the development of isolated gastric varices (IGV) in non-cirrhotic patients and potentially life-threatening upper gastrointestinal bleeding. We report a case of pancreatic cancer causing left-sided portal hypertension (LSPH) and isolated gastric varices bleeding. Pancreatic cancer is one of the leading causes of cancer-related death globally. Symptoms are non-specific, and there are no routine screening tests; therefore, the disease tends to be diagnosed in advanced stages. A high suspicion index and systematic diagnosis approach are needed, including inflammatory, infiltrative, and oncological causes, to establish a proper diagnosis.

Keywords: case report; gastric varices; left-sided portal hypertension; pancreatic cancer; sinistral portal hypertension.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Multimodal imaging findings
(A) EGD: arrows showing IGV1. (B) Angiography demonstrating a large gastrorenal shunt (outflow) directed toward the left renal vein. (C) Abdominal enhanced CT scan in portal venous phase: arrows showing dilated portal vein and splenomegaly. (D) Abdominal enhanced CT: arrow showing a hypodense pancreatic lesion. EGD: esophagogastroduodenoscopy, IGV1: isolated gastric varices type 1, CT: computed tomography
Figure 2
Figure 2. Schematic diagram showing the pathophysiology of LSPH
Splenic vein occlusion leads to splenic venous hypertension, which results in the diversion of flow through the SGV, PGV, and GEV. Splenofugal flow in PGV and SGV forms gastric fundal varices and drains into the PV via LGV. GEV also drains splenic venous flow to PV. LSPH: left-sided portal hypertension, SGV: short gastric vein, PGV: posterior gastric vein, GEV: gastroepiploic vein, PV: portal vein, LGV: left gastric vein, SV: splenic vein Adapted with permission from Patel et al. [17]
See this image and copyright information in PMC

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