119) A 60-year-old woman presents to the Emergency Room with massive hemetemesis. The onset is acute. She denies any alcohol use or any antecedent nausea, vomiting or retching. On physical examination, the patient is found to be hypotensive with a blood pressure of 80/40. The patient is started on Intravenos fluids and proton pump inhibitors. Prothrombin time and liver function tests are with in normal limits. Hemoglobin is low at 7gm/dl and the patient is now being transfused with 2 units of packed red cells. An immediate Endoscopy is scheduled which revealed bleeding gastric varices but no esophageal varices. Local vasocontrictor therapy and band ligation could not restrain thebleeding. Ultrasound and CT scan of abdomen revealed enlarged spleen, an engorged splenic artery and an intraluminal filling defect in the Splenic Vein as shown in the picture below
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dddddd
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a
a
d
CBC
D
The condition is isolated splenic vein thrombosis, which is most commonly due to chonic pancreatitis.
D
Splenic vein thrombosis results in sinistral or left sided portal hypertension.
D
3 Ds
d
d
d
D
D
D
d
d
d
E
D
D
d,d,d
CT abdomen may show mass at tail of pancreas,splenomegaly and splenic vein thrombosis
sure
d
d
d