Splenic variceal haemoperitoneum mimicking splenic trauma managed by transjugular intrahepatic portosystemic shunt

A man in his 50s presented with abdominal pain and haemodynamic instability following a fall. CT imaging suggested haemoperitoneum with suspected splenic venous injury and revealed previously undiagnosed cirrhosis with portal hypertension. The patient was admitted and managed conservatively. However, he developed persistent anaemia and hypotension despite repeated blood transfusion. Diagnostic paracentesis performed to evaluate possible spontaneous bacterial peritonitis yielded frank blood. Repeat imaging demonstrated increasing haemoperitoneum within the left upper quadrant. The patient developed haemorrhagic shock and underwent laparotomy, revealing extensive haemoperitoneum and splenic vascular bed bleeding without parenchymal injury. Portal hypertensive bleeding from splenic varices was suspected. Portal decompression with transjugular intrahepatic portosystemic shunt was performed, with haemodynamic improvement and cessation of bleeding upon repeat laparotomy. This case is among the few reported examples of traumatic rupture of ectopic varices, managed with transjugular intrahepatic portosystemic shunt alone, emphasising the importance of early recognition and portal decompression.