Isolated Gastric Variceal Bleeding: A Sentinel Sign of Pancreatic Neoplasm Manifesting as Sinistral Portal Hypertension.

Sinistral portal hypertension (SPH) is an uncommon condition secondary to stenosis of the splenic vein. The most common causes are chronic pancreatitis and pancreatic cancer. This localized hypertension can lead to the development of isolated gastric varices (IGV) in non-cirrhotic patients and potentially life-threatening upper gastrointestinal bleeding. We report a case of pancreatic cancer causing left-sided portal hypertension (LSPH) and isolated gastric varices bleeding. Pancreatic cancer is one of the leading causes of cancer-related death globally. Symptoms are non-specific, and there are no routine screening tests; therefore, the disease tends to be diagnosed in advanced stages. A high suspicion index and systematic diagnosis approach are needed, including inflammatory, infiltrative, and oncological causes, to establish a proper diagnosis.