Domino effect from hypertriglyceridemia to sinistral portal hypertension.

Patient with hypertriglyceridemia history tends to develop a pancreatitis episode. Triglyceride levels > 1000 mg/dl may trigger this pathology. Amylase is not a good predictor for pancreatitis associated with hypertriglyceridemia. Because of the close relation between pancreas and splenic vein, pancreatitis is the most common etiologic factor in developing thrombosis or occlusion in splenic vein. The impairment or cessation of venous flow in splenic vein results in back pressure which is transmitted through short gastric and gastroepiploic veins and subsequently via the coronary vein into the portal system. Increased flow across the short gastric veins creates sinistral portal hypertension. Recurrent upper gastrointestinal hemorrhage is the last scene of this sequence in general, and may be unique sign. This case is extremely rare to understand all the cascade mechanism at once.