The splenic vein drains the spleen, runs along the posterior surface of the pancreas in a groove, receives the short gastric and left gastroepiploic veins and the inferior mesenteric vein, and joins the superior mesenteric vein behind the pancreatic neck to form the portal vein. It is closely related to the pancreatic body and tail throughout its course.
The splenic vein is intimately adherent to the posterior pancreatic capsule and is at risk during distal pancreatectomy, which may require planned splenic vein ligation with splenectomy. Pancreatic body carcinoma encases the splenic vein, making unresectability more common for body tumours than head tumours. Splenic vein thrombosis from pancreatitis or pancreatic cancer produces sinistral (left-sided) portal hypertension with isolated gastric varices without oesophageal varices, and splenomegaly.
Splenic vein thrombosis from chronic pancreatitis or pancreatic malignancy produces isolated left-sided portal hypertension with splenomegaly and gastric fundal varices without oesophageal varices, a pattern treated by splenectomy rather than portosystemic shunting.
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