Pharyngeal Varices Secondary to Sinistral Portal Hypertension

A 60-year-old man presented with hematemesis. He had been diagnosed with pancreatic tail cancer and gastric varices due to sinistral portal hypertension, which had been observed on computed tomography (CT). An upper gastrointestinal endoscopy was undertaken to assess the gastric varices, and a recent gastric variceal bleed was suggested (Figure 1). Although splenectomy was a definitive therapy, considering his prognosis and the possibility of unknown shunts, endoscopic variceal ligation (EVL) was performed to achieve hemostasis due to the risk of embolization with other methods. Endoscopy also demonstrated pharyngeal varices with no signs of bleeding (Figure 2). After treatment, CT showed no evident cause of the pharyngeal varices; however, the left inferior phrenic vein ended in the left hepatic vein and formed a gastrocaval shunt (Figure 3). The bleeding ceased without any complication, and no further bleeding was observed