Atypical Presentation of Isolated Gastric Variceal Bleeding Requiring Multidisciplinary Management

Variceal bleeding is the most lethal manifestation of portal hypertension, most commonly due to esophageal varices in the setting of liver cirrhosis. Isolated gastric varices (IGV) are a rare cause of upper gastrointestinal bleeding, often of pancreatic origin. In this case we present a complex patient with a history of remote splenic injury leading to portopulmonary hypertension and the development of refractory bleeding due to IGV. We discuss the extensive multidisciplinary approach taken to provide comprehensive care and to control bleeding, which included endoscopic (sclerotherapy), radiologic (balloon-occluded antegrade transvenous obliteration [BATO] and splenic artery embolization) and surgical interventions (splenectomy).