0:00

Okay, so here's our case with the

0:02

SMV and splenic vein thrombosis.

0:05

Again, I say it's very hard to know clinically whether

0:07

or not you have to anticoagulate these people, and

0:09

how to anticoagulate them safely because of the risk

0:12

of hemorrhagic conversion of their pancreatitis.

0:15

But another entity to be aware of is the fact that,

0:18

you know, whenever you have a thrombosis of any vessel.

0:21

The body's like plumbing; water will

0:22

always flow, and it will find a route.

0:25

So in the cases of splenic vein thrombosis, where

0:28

that splenic vein goes posterior to the pancreas,

0:30

living in that evil neighborhood next to the

0:32

pancreas, um, when it becomes thrombosed, the spleen

0:35

still has to drain the blood, and as a result, the

0:38

spleen will develop hypertrophied gastric varices.

0:41

This is a cause of isolated gastric varices.

0:44

That can occur when the splenic vein is

0:46

thrombosed, either from pancreatitis or

0:48

from cancer, and that can be a problem.

0:50

If you are an interventionalist, you

0:52

want to be careful not to cause significant

0:54

bleeding during a G-tube placement.

0:57

Let's take a look at this patient just a couple

0:59

weeks after their initial insult and that

1:01

splenic vein thrombosis as we come down here.

1:05

We're going to see very large

1:08

hypertrophied varices around the stomach.

1:10

Those are big draining vessels.

1:12

You can imagine that if you weren't careful

1:15

and you put your percutaneous drainage

1:17

catheters straight through, that you could

1:18

cause significant bleeding in the patient.

1:20

It's also a reason why these isolated gastric varices.

1:25

If an endoscopist ever goes into the stomach and

1:28

sees isolated gastric varices, meaning there's not

1:30

significant esophageal varices, they are oftentimes

1:33

very concerned that there is splenic vein thrombosis.

1:37

Here you can see the lack of splenic vein.

1:39

And if a patient hadn't had pancreatitis, you know, you

1:41

might be concerned that they have a pancreatic cancer

1:43

or some other reason for a splenic vein thrombosis.

1:46

So isolated gastric varices are seen in the setting of

1:49

splenic vein thrombosis because water always flows,

1:53

and the spleen is going to get its blood from the artery,

1:55

and it needs to figure out a way to drain the blood.

1:58

Always think of the path of least resistance.