Massive Splenomegaly Secondary to Hematologic Dyscrasia

Massive splenomegaly refers to a marked and clinically significant enlargement of the spleen beyond normal limits. Although uncommon, it is clinically significant because it may be associated with hematologic, infectious, infiltrative, malignant, or portal hypertensive disorders. Chronic hemolytic anemias are a recognized cause of marked splenic enlargement due to persistent erythrocyte destruction and reticuloendothelial hyperplasia. Ongoing hemolysis also increases bilirubin production, predisposing patients to pigment gallstone formation and biliary tract disease. We report the case of a 29-year-old male who presented with jaundice and imaging findings consistent with choledocholithiasis. His medical history was notable for chronic hemolytic anemia and recurrent episodes of jaundice. Magnetic resonance cholangiopancreatography confirmed common bile duct stones and marked splenomegaly. The patient underwent exploratory laparotomy with splenectomy and common bile duct exploration followed by choledochoduodenal anastomosis. Intraoperatively, a massively enlarged spleen and hepatomegaly were identified. Significant bleeding from the splenic pedicle required vascular control and a blood transfusion. The postoperative course was favorable, with progressive reduction in bilirubin levels and no evidence of further complications. Histopathological examination demonstrated a congestive spleen with extensive hemorrhagic areas. This case highlights the importance of a multidisciplinary approach in the evaluation and management of massive splenomegaly and illustrates that timely surgical treatment can achieve satisfactory outcomes in selected patients.