Small bowel varices (SBVs) are a rare but important cause of gastrointestinal (GI) bleeding. We present a case of SBVs caused by superior mesenteric vein thrombosis from a large neuroendocrine tumor of the pancreas. This patient presented with GI bleeding. A computed tomography scan showed an incidental hypervascular mass that was unresectable. After exhaustive work-up, the GI bleeding was in fact due to the mass by direct compression on the superior mesenteric vein. The SBVs were evident on the venous phase of a computed tomography angiogram. The patient was treated medically with octreotide, β-blockade, and external beam radiation therapy applying the physiology of esophagogastric varices to the small bowel. Persistent GI bleeding in the presence of a large central mass should always alert one to consider varices from collateral flow as a possible cause.
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