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Thrombosis of the splenic vein is a rare cause of variceal bleeding. The blood, blocked from its normal route, flows through the short gastric veins, continuing towards the liver. Large gastric varices may develop as the blood traverses the stomach; later, these may rupture and bleed. Oesophageal varices are uncommon because the collateral pattern does not involve the oesophagus.
The principal causes of splenic vein thrombosis include pancreatitis, pancreatic pseudocyst, neoplasm and trauma. In two-thirds of patients, there is splenomegaly.
Diagnosis is made by selective splenic arteriography.
In the presence of varices only, the recommended treatment is by splenectomy. Otherwise, no therapy is required.