Splenic variceal haemoperitoneum mimicking splenic trauma managed by transjugular intrahepatic portosystemic shunt.
Faris Gondal, Joshua Haron Abasszade, Neeraj Bhala et al.
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Case in brief
A man in his 50s presented with abdominal pain and instability after a fall. CT imaging indicated haemoperitoneum and revealed undiagnosed cirrhosis with portal hypertension. Despite conservative management, he developed persistent anaemia and hypotension, leading to a laparotomy that identified bleeding from splenic varices. Treatment with a transjugular intrahepatic portosystemic shunt resulted in haemodynamic improvement and cessation of bleeding.
What made this case unusual
This case highlights a rare instance of traumatic rupture of ectopic varices, managed effectively with transjugular intrahepatic portosystemic shunt, without parenchymal splenic injury.
Diagnostic / clinical pearl
Clinicians should consider splenic variceal bleeding in patients with portal hypertension presenting with abdominal trauma, as it can mimic splenic injury.
Why it matters
Recognizing the potential for variceal bleeding in trauma cases can lead to timely intervention and improved patient outcomes.