Gastric varices are less common than esophageal varices in patients with portal hypertension, occurring in up to 33% of patients Gastric varices are more common in patients with noncirrhotic portal hypertension and extra hepatic portal vein thrombosis, are associated with a lower incidence of bleeding, and have a higher mortality rate than esophageal varices. Optimal management of gastric variceal bleeding is debatable, because of lack of data from large randomized controlled trials. Gastric variceal bleeding may be caused by portal hypertension or splenic vein thrombosis. In the context of portal hypertension, emergency TIPS is often successful in controlling hemorrhage. Splenectomy is often reserved for patients with isolated splenic vein thrombosis, and in the context of multiple splanchnic and portal thrombosis, treatment is more complicated. We report that splenectomy was a successful treatment for this patient with gastric varices and multivessel extra hepatic thrombosis secondary to essential thrombocythemia. Gastric variceal bleeding may be caused by portal hypertension or splenic vein thrombosis. In the context of portal hypertension, emergency TIPS is often successful in controlling. Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. In most people, GERD doesn’t cause serious complications. But in rare cases, it can lead to serious or even lifethreatening health problems. Gastric varices are an important Porto systemic collateral pathway, occurring in ~20% of patients with portal hypertension. They are considered distinct from oesophageal varices in that they have a propensity to haemorrhage at comparatively lower portal pressures, and are also associated with higher mortality rate with hemorrhage. The patients with cirrhosis or high portal blood pressure are highly prone to gastric variceal bleeding than the patients with splenic vein thrombosis (SVT).