P0261 - Pancreatic Cancer Portal Hypertension and Pan-Colonic Varices as a Consequence for Chronic Pancreatitis

Farah Heis, MD¹, Jayasree Ravilla, MD², Mahrukh Khan, MD^1
1Rutgers Health/Monmouth Medical Center, Long Branch, NJ; ²Monmouth Medical Center/RWJBH, Long Branch, NJ

Introduction: Chronic pancreatitis (CP) can rarely cause Left-sided portal hypertension which can be asymptomatic or present with UGIB. It also leads to the development of pancreatic cancer which has been rarely associated with pan-colonic varices. We present an unusual case of a 72 yo M with CP and pancreatic cancer who suffered from both rare entities.

Case Description/Methods: 72 yo M with PMH of idiopathic chronic pancreatitis, pancreatic cancer s/p Whipple procedure, chronic splenic venous thrombosis, non-cirrhotic portal HTN, and CAD who presented to the ED with constipation and BRBPR for 5 days. He reported anorexia, dysphagia, and early satiety for weeks. He denied nausea, vomiting, chest pain, history of Etoh consumption or smoking. Vital Signs on admission were wnl. Labs showed Hgb of 10.7 g/dL, MCV 98.5fL, CMP was wnl except for elevated BUN of 32mg/dL and Creatinine of 1.47 mg/dL. X-ray of the abdomen with non-significant findings. US Abdomen showed splenomegaly. CT of the abdomen showed Peri-pancreatic and peri-splenic varices and benign liver. Patient was admitted for BRBPR and dysphagia of unknown etiology. He had an EGD which showed Portal HTN gastropathy and esophageal varices with red wale sign, so 2 bands were placed. Colonoscopy showed non-bleeding varices throughout the colon, rectal varices, non-bleeding diverticulosis throughout colon, however no masses/tumors were noted. Patient remained hemodynamically stable and had stable Hgb throughout his hospitalization with no episodes of bleeding. He was discharged on PPI BID with potential splenectomy given chronic splenic vein thrombus with diffuse varices. He was later brought to the ED for a fractured femoral head due to mechanical fall. He rapidly became hypotensive requiring pressors. The family at that point opted for Hospice care and no further luminal evaluation was done.

Discussion: Left-sided portal hypertension is a rare entity, most patients are asymptomatic, and others present with UGIB. It is associated with chronic pancreatitis and pancreatic cancer. Ectopic pan-colonic varices is another rare entity associated with pancreatic cancer and can present similarly. Both should be considered when evaluating for GIB causes in patients with pancreatic pathologies.


Disclosures:


Farah Heis, MD¹, Jayasree Ravilla, MD², Mahrukh Khan, MD¹. P0261 - Pancreatic Cancer Portal Hypertension and Pan-Colonic Varices as a Consequence for Chronic Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.