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Post traumatic intra thoracic spleen presenting with upper GI bleed!--a case report
Deepak Hariharan1, Rishi Singhal, Sonali Kinra
1Hepato biliary & pancreatic Surgery, Royal London Hospital, London, UK. hariharandeepak@hotmail.com <hariharandeepak@hotmail.com>
BMC Gastroenterology
|November 30, 2006
Summary
Isolated splenic vein thrombosis can cause upper gastrointestinal bleeding due to left-sided portal hypertension. This rare condition, often linked to trauma, requires high suspicion for diagnosis.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Radiology
Background:
- Isolated splenic vein thrombosis is a rare cause of upper gastrointestinal bleeding.
- Left-sided portal hypertension, a consequence of splenic vein thrombosis, presents diagnostic challenges.
- High index of suspicion is crucial in patients with gastrointestinal bleeding, splenomegaly, and normal liver function.
Observation:
- A 64-year-old male presented with hematemesis and melena.
- Upper gastrointestinal endoscopy revealed gastric antral erosions and fundal varices.
- CT scan showed a diaphragmatic tear, spleen herniated into the left hemithorax, and splenic vein thrombosis.
Findings:
- Splenic vein thrombosis secondary to trauma leading to left-sided portal hypertension is rare.
- Splenic herniation into the left hemithorax is an unusual presentation.
- Fundal varices developed 28 years post-trauma, causing upper gastrointestinal bleeding.
Implications:
- This case highlights a rare, long-term complication of diaphragmatic injury.
- Delayed diagnosis of splenic vein thrombosis can lead to significant gastrointestinal bleeding.
- The unusual splenic herniation emphasizes the need for comprehensive imaging in trauma patients with unexplained symptoms.
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