Background and Aims The incidence and diagnosis rate of pancreatic-related diseases have been increasing in recent years, leading to a corresponding rise in the incidence and diagnosis rate of pancreatic portal hypertension (PPH) and its complications. PPH can manifest with symptoms such as abdominal pain, splenomegaly, and gastrointestinal bleeding. Gastric venous rupture bleeding is the most severe complication of PPH, which can result in hemorrhagic shock and even death. Currently, there is no recognized standard for predicting the risk of gastric venous rupture bleeding in patients with PPH. Therefore, this study explored the relevant risk factors for gastric variceal rupture/bleeding in PPH patients and established a risk prediction model to provide a reference for preventing and treating this condition in clinical practice.Methods A total of 176 patients with PPH admitted to the First Affiliated Hospital of Hunan University of Chinese Medicine and Hunan Provincial People's Hospital from January 2012 to January 2022 were included in this study. Patients were divided into bleeding group (24 cases) and non-bleeding group (152 cases) based on whether they developed gastric venous rupture bleeding. General information including sex age, etiology, hypertension, and diabetes, laboratory results such as splenomegaly, prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), activated partial thromboplastin time (APTT), and imaging indicators including the inner diameter of the left gastric vein (LGV), the inner diameter of the gastroesophageal vein (GEV), and the GEV inner diameter /LGV inner diameter ratio were collected for both groups. Univariate and multivariate Logistic regression analyses were conducted to identify the influencing factors for PPH complicated with gastric variceal rupture/bleeding, a nomogram risk prediction model was established, and then the predictive efficacy, consistency, and clinical value of the model were evaluated through receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis.Results Univariate analysis showed that diabetes, splenomegaly, PT, FIB, LGV inner diameter, and GEV inner diameter/LGV inner diameter ratio were associated with PPH complicated with gastric variceal rupture/bleeding (all P<0.05). Multivariate Logistic regression analysis revealed that diabetes (OR=0.144, 95% CI=0.031-0.675, P=0.014) and LGV diameter (OR=3.129, 95% CI=1.608-6.090, P=0.001) were independent risk factors for PPH complicated with gastric venous rupture bleeding, while FIB (OR=0.580, 95% CI=0.348-0.966, P=0.037) and GEV/LGV ratio (OR=0.024, 95% CI=0.001-0.696, P=0.030) were independent protective factors. A nomogram model for predicting the risk of gastric venous rupture bleeding in PPH incorporating these factors and clinically significant GEV inner diameter demonstrated an area under the ROC curve of 0.954. The calibration curve and decision curve analysis showed high fitting degree and net benefit values when the risk threshold was between 2% and 85%.Conclusion Diabetes, LGV inner diameter, FIB, and GEV inner diameter/LGV inner diameter ratio are closely related to PPH complicated with gastric venous rupture bleeding. The established nomogram risk prediction model can effectively identify high-risk patients for gastric venous rupture bleeding in PPH and provide a reference for clinical decision-making.