Polycythaemia vera presenting as an acute abdomen

Area of Science:

• Hematology
• Internal Medicine
• Gastroenterology

Background:

• Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by increased red blood cell mass.
• Intrahepatic hematomas are rare but serious complications that can arise from various conditions.
• Undiagnosed PV can present with atypical symptoms, complicating diagnosis and management.

Observation:

• A patient presented with severe abdominal pain, which was diagnosed as an intrahepatic hematoma.
• The hematoma was found to be a complication of previously undiagnosed polycythemia vera (PV).

Findings:

• The patient experienced a full recovery following conservative management, including bed rest and hypertension control.
• Treatment also involved daily venesection and phosphorus-32 (32P) therapy.
• The case underscores the significant risks associated with surgical interventions in patients with uncontrolled PV.

Implications:

• This case highlights the importance of considering hematological disorders like PV in patients presenting with unexplained abdominal complications.
• Early diagnosis and appropriate management of PV are crucial to prevent severe complications.
• The findings emphasize the need for careful risk assessment before surgical procedures in patients with known or suspected PV.