Background. Pancreatic cancer is a highly lethal malignancy with few effective therapies. Pancreatic cancer is often associated with thromboembolic disease, as the malignant condition induces a prothrombotic and a hypercoagulable state. Case report. This is a case of a 63 years old patient, diagnosed with pancreatic cancer with hepatic and splenic metastasis detected on CT, with a level of Carbohydrate antigen (CA) 19-9 of 2556 UI/ml and several associated comorbidities: a moderate form of iron deficiency anemia ( Hb -7.4 g/dL, Ht - 25.2%, serum iron - 3.28 μmol/L), large gastric varices at the level of the fornix secondary to segmental portal hypertension, but with no signs of bleeding, incomplete intestinal metaplasia and Helicobacter Pylori infection at the level of the antrum and type 2 diabetes insulin dependent. The patient presented in our Medical Clinic complaining pain and functional impotence of the right inferior limb. We performed a Doppler ultrasound that revealed femoral-popliteal-tibial thrombosis of the right inferior limb and thrombosis of the internal saphenous vein. Due to the association of the thrombotic disease with the gastric varices, the initiation of antithrombotic therapy was questioned because of the high risk of variceal rupture and massive bleeding. The patient was recommended endoscopic injection sclerotherapy, but the procedure could not be performed due to the lack of compliance. A treatment the with low molecular weight heparin (Fragmin 2500 IU) and Vessel Due F was initiated. The patient condition was ameliorated during the admission and she was discharged with oncological and gastroenterological follow-up. Conclusions. The peculiarity of this case consists in the association of the thrombotic condition with the gastric varices, both as complications of pancreatic cancer. The treatment in this case has to be carefully chosen, as the patient is at high risk of developing both gastric bleeding and thrombotic embolism.