Splenic Vein Thrombosis (SpVT) is a prevalent case in male patients during their fifth decade of life. Generally, patients complain of abdominal pain, gastrointestinal bleeding, and spleen enlargement. The SpVT results in an elevated localized sinistral portal pressure, also known as left portal hypertension. Most patients have left portal hypertension with no significant symptoms and normal liver function, but still, gastrointestinal bleeding secondary to esophageal or gastric varices commonly arises. Nonetheless, many patients with peripheral artery SpVT, other than gastric varices, rarely bleed. As patients without esophageal varices are asymptomatic, treatment is discretional with intensive monitoring.

Referring to SCAR 2020 Guidelines, the authors reported a rare case of a non-hepatitis B and C liver cirrhosis patient developing Splenic Vein Thrombosis (SpVT). The SpVT in a young patient with non-hepatitis B and C cirrhosis of the liver is an infrequent case generating hemorrhagic manifestations. The authors herein reported a 28-year-old man with hematemesis, melena, and features of liver cirrhosis. Hematemesis, melena, and ascites resolve following conservative treatment. Abdominal ultrasound confirmed portal hypertension. Serial endoscopy on day 14, 17, and 1-month evaluation showed grade II-III esophageal varices and severe hypertensive portal gastropathy. Abdominal CT scan with contrast within a week after discharge revealed thrombus along ± 5.8 cm, splenomegaly with dilated splenic vein, dilatation, and tortuosity of the left gastric vein, and visualized distal esophageal vein.

A liver biopsy conducted 2 months after hospitalization showed hepatocytes with extensive hydropic degeneration with SpVT fibrosis, which rarely occurs in patient with non-B and C liver cirrhosis. Bleeding manifestations are emergencies in need of comprehensive management. Proper imaging, i.e. abdominal CT with contrast helps diagnose SpVT. Serial EGD evaluation is required to evaluate complications of esophageal varices that possibly reappear at any time.

Author: Husin Thamrin, dr.,Sp.PD.FINASIM

Journal: https://www.sciencedirect.com/science/article/pii/S2049080122011992