Post traumatic intra thoracic spleen presenting with upper GI bleed!--a case report.
BACKGROUND
Isolated splenic vein thrombosis with left sided portal hypertension is a rare cause of upper gastrointestinal bleed. Diagnosis is difficult and requires a high index of suspicion, especially in patients presenting with gastrointestinal bleed in the presence of splenomegaly and normal liver function tests.


METHODS
A 64 year old male presented with haematemesis and melaena. An upper gastrointestinal endoscopy revealed the presence of antral erosions in the stomach and fundal varices. A computerised tomography scan of abdomen confirmed the presence of a diaphragmatic tear and the spleen to be lying in the left hemi thorax. The appearances of the splenic vein on the scan were consistent with thrombosis.


CONCLUSIONS
Left sided portal hypertension as a result of isolated splenic vein thrombosis secondary to trauma is rare. The unusual presentation of our case, splenic herniation into the left hemithorax, causing fundal varices leading to upper gastrointestinal bleed 28 years after the penetrating injury, makes this case most interesting. We believe that this has not been reported in literature before.
Hariharan
Deepak
D
Hepato biliary & pancreatic Surgery, Royal London Hospital, London, UK. hariharandeepak@hotmail.com <hariharandeepak@hotmail.com>
Singhal
Rishi
R
Kinra
Sonali
S
Chilton
Andrew
A
D000007:Abdominal Injuries / Q000150:complications*; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries; D005748:Gastric Fundus / Q000098:blood supply; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006547:Hernia / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D022125:Lacerations / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D013902:Radiography, Thoracic; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D013162:Splenic Vein; D013909:Thorax; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology; D014951:Wounds, Stab / Q000150:complications*