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A Journal on Surgery

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Chirurgia 2009 December;22(6):259-61

language: English

Myocardial revascularization complicated with intraoperative splenic rupture in a patient with polycythemia vera

Velicki L., Susak S., Mihajlovic B., Gluhovic A

1 Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
2 Clinic for Abdominal, Endocrine and Transplantation Surgery, Institute for Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia


It is well established that certain perioperative factors and conditions may cause gastrointestinal complications in cardiac patients. Polycythemia vera, rare hematological condition, is often characterized with enlarged, fragile and easily injured spleen. We describe the case of elective myocardial revascularization complicated with spontaneous splenic rupture in the patient with polycythemia vera and known splenomegaly. During the on pump cardiac surgery, onset of hemodynamic instability occurred. After ruling out the possibility of cardiac causes, we suspected major intra-abdominal bleeding which was confirmed after explorative laparotomy. In the same act, splenectomy was performed and the hemodynamic stability was regained. This case suggests that, although rare, splenic rupture should be considered in the differential diagnosis of abrupt onset of hemodynamic instability especially in the case of pre-existing conditions such as polycythemia vera with splenomegaly.

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