Specific Gastric Blood Vessels in Sinistral Portal Hypertension.

Advanced pancreatic cancer is a highly uncontrollable disease that is encountered throughout the world. Occlusion of the splenic vein as a result of hematemesis is suspected to be a cause sinistral portal hypertension (SPH) in patients with pancreatic cancer (1). We herein report the case of a patient with pancreatic cancer in whom the specific gastric blood vessel that caused bleeding was identified. Abdominal CT and macroscopic pathology showed a tumor of the pancreas that invaded the splenic vein (Picture 1). A large amount of melena was observed in the gastric varices of the upper stomach (Picture 2. white arrow); bridging vessels were identified among these varices that have not been previously reported (Picture 2. yellow arrow). Microscopy revealed that the gastric varices were located in the submucosa (Picture 3. white arrow) and the bridging vessels were located in the mucosal layer (Picture 4. yellow arrow). A healed mucosal layer was observed above these vessels, which we recognized as the bleeding point on autopsy (Picture 4). The development of bridging vessels in the mucosal layer due to SPH may be a cause of melena (2).

Picture 1.

Picture 2.

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Picture 4.

The authors state that they have no Conflict of Interest (COI).