**6.4 Gastro-intestinal bleeding, related to**

#### **a. Portal hypertension**

Patients who have bled from gastric varices related to segmental portal hypertension as a consequence of splenic vein thrombosis can usually be managed with distal pancreatectomy.

#### **b. Pseudoaneurysms**

Where angiographic embolisation has failed to control a bleeding pseudoaneurysm vascular control may be achieved using a Frey-type procedure in preference to a more extensive resection which may be hazardous under these circumstances, while bleeding from the tail can usually be dealt with safely by means of a distal pancreatectomy (Bornman PC S Afr Med J 2010).

Surgery for suspected malignancy should utilize either a pancreatico-duodenectomy or distal pancreatectomy depending on tumour location and should be performed in keeping with the oncological principle of clear resection margins.
