Gastroesophageal variceal bleeding secondary to neuroendocrine pancreatic tumor Hemorragia por varizes esófago-gástricas secundária a tumor neuroendócrino pancreático

A 53-year-old woman was admitted to the emergency department with melena over the preceding 12 h. The patient reported previous symptoms of bloating and early satiety for about 6 months, but no past history of gastrointestinal or liver diseases was known. The physical examination evidenced a deformity in the abdominal wall, secondary to a large palpable stony mass in the epigastrium, and hepatomegaly. No other signs of liver disease were apparent and the hemodynamic parameters were normal. The initial laboratory study disclosed anemia (hemoglobin 9.5 g/dL), and a slight elevation of alkaline phosphatase (185U/L) and gamma-glutamyltransferase (40U/L). An emergent upper gastrointestinal endoscopy was performed, showing an active spurting bleed from a subcardial gastroesophageal varix, successfully controlled with endoscopic band ligation. In order to clarify the nature of the abdominal mass and the etiology of the portal hypertension, the patient underwent an abdominal computed tomography (CT) scan, which revealed a large hypervascular pancreatic tumor (Fig. 1), contiguous to the left hepatic lobe, stomach and