3139 Variceal Bleeding, Beyond the Liver Disease: Case Report

Abstract

INTRODUCTION: Varices are dilated blood vessels in the esophagus or stomach caused by portal hypertension. They cause no symptoms unless they rupture and bleed, which can be life-threatening (1). We report unusual cause of variceal bleeding which is polycythemia rubra Vera causing splenic vein thrombosis. Splenic vein thrombosis (SVT) is known as one of the rare causes of upper gastrointestinal bleeding and is mostly seen in the fifth decade of life and male sex (2). CASE DESCRIPTION/METHODS: 39 years old Lady presented to the emergency room with history of hematemesis and melena for 2 days. She had chronic headache for that she is advised to take paracetamol but did not work, so she took ibuprofen. She had more epigastric pain for which she took continuous ibuprofen too. She never had symptoms of dizziness, black out/syncope or palpitations with/without standing. Although she had active hematemesis and melena but her hemoglobin never dropped below 10 g/dl. She had no history of any chronic illness or surgical intervention. She was not smoker and denied alcohol intake. Gastroscopy revealed: Esophagus: normal, no varices Stomach: full of blood and there is large clot in the fundus. Large fundal varices (tortuous and complex). Isolated gastric varices IGV1: 2 large FIII ulcer seen in the fundus with one visible blood vessel seen on one gastric fold just near to gastroesophageal junction (Dieulafoy's lesion) which is typical for location. One rubber band was applied on the visible vessel. 1 mg histoacryl was injected in varices and hemostasis is maintained. Duodenum: normal. DISCUSSION: isolated obstruction (mainly due to thrombosis) of the splenic vein usually results in left-sided portal hypertension and isolated fundal varices formation. This syndrome is a rare cause of gastrointestinal bleeding. Pancreatic diseases are among the most common etiologies of splenic vein obstruction. Renal disorders are rarely reported as a cause of splenic vein thrombosis 3. We screen for most thrombophilia causes (Table 1). So, we deal with patient with Non cirrhotic liver. Isolated splenic vein thrombosis. Massive splenomegaly Negative hemophilia screen. No evidence of pancreatitis or pancreatic mass on cross sectional imaging. When we review her lab we noted that she had persistently high WBC, platelet and Hematocrit despite GI bleeding, so we screened for myeloproliferative Disorders, and we found mutation for JAK 2 exon 12 is positive. And this patient met the WHO criteria for polycythemia Vera. thrombophilia screen negative.