No abstract
Splenic vein thrombosis secondary to polycythemia vera is a rare disorder, only 1 case having been reported in the medical literature. The authors report the second case of isolated splenic vein thrombosis due to polycythemia vera presenting as upper gastrointestinal hemorrhage, which was cured by splenectomy at their institution. The literature and management of this problem are reviewed. Case ReportA fifty-three year-old woman was admitted to South Macomb Hospital on January 23, 1985, with a two-day history of passing black, tarry stools. One day prior to admission she had an episode of fainting and passed black stools. There was no history of alcohol intake, abdominal trauma, or symptoms compatible with pancreatic or hepatic disease.Physical examination: blood pressure 118/70, pulse 88/min, temperature 37.2°C. Lungs were clear, heart was enlarged, and an ejection systolic murmur was heard in the parasternal area. Abdominal examination revealed massive splenomegaly. Liver function tests were essentially normal, stools were positive for occult blood, hemoglobin was 7.6 gm % , white blood cell count was 25,600/mm3, and platelets were 500,000/mm3. This patient has had repeated admissions to the hospital for polycythemia vera and had multiple phlebotomies. Her first admission was in August, 1983, when she had a hemoglobin of 17.6 gm % with a hematocrit of 55 .1 % and a red blood cell (RBC) count of 6.84 x 106. In September, 1983, she was admitted with acute vertigo, recurrent emesis, and constricted feeling in the chest. On examination large spleen was palpable in the left upper quadrant, and
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