Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical Surgery2070-478X2409-143XVoronezh State Medical University123510.18499/2070-478X-2019-12-2-123-126UnknownClinical Case of Tubular Gastrectomy and Splenectomy, the Bleeding from Vericose Veins of the Stomach and Splenomegaly in the Background Idiopathic Myelofibrosis in Urgent SurgeryBagryantsevMaxim Vladimirovich<p>surgeon of the surgical Department</p>maks-bagryancev@mail.ruhttps://orcid.org/0000-0003-2230-9431ErshovVladimir Vasilevich<p>associate Professor, scientific consultant of the surgical Department</p>maks-bagryancev@mail.ruCity clinical hospital № 30, Nizhny Novgorod2903201912212312617092018Copyright © 2019, Bagryantsev M.V., Ershov V.V.2019<p><strong>Relevance</strong>. Treatment of patients with surgical complications of oncohematological diseases is difficult due to their inherent critical disorders of blood coagulation, dependence of patients on hormonal drugs taken in connection with the existing pathology, as well as instability of systemic hemodynamics. Such patients are rarely hospitalized in a surgical hospital and can be classified as "difficult patients " because of the polysyndromic nature of the underlying disease and the high risk of death from complications of the disease.</p>
<p>One of the most common oncohematological diseases is chronic idiopathic myelofibrosis, it is characterized by bone marrow fibrosis, hepato-splenomegaly (due to extramedullary hematopoiesis), as well as anemia. The clinical picture of primary (idiopathic) myelofibrosis is diverse and has no pathognomonic syndromes. Centers of extra-medullary hematopoiesis may occur in the liver with long-term disease, and thrombosis of splenic vein is possible, which can lead to subhepatic portal hypertension.</p>
<p>In the available literature, we have found information on the successful treatment of bleeding from varicose veins of the stomach in a patient with splenic vein thrombosis and splenomegaly by performing only splenectomy preserving gastric varices, which does not completely eliminate the risk of re-bleeding. We found no publications on splenectomy with vertical tubular resection of the stomach at the height of bleeding from varicose veins of the stomach in a patient with myelofibrosis of the spleen.</p>
<p><strong>The aim</strong> is to show the possibility of performing a simultaneous operation (vertical tubular resection of the stomach and splenectomy) for bleeding from varicose veins of the stomach and splenomegaly against the background of idiopathic myelofibrosis in urgent surgery with impossible endoscopic hemostasis and to draw the attention of specialists in the field of surgery to the risk of bleeding in this group of patients.</p>
<p><strong>Materials and methods.</strong> The article describes a clinical case of vertical tubular resection of the stomach and splenectomy for bleeding from varicose veins of the stomach and splenomegaly on the background of idiopathic myelofibrosis in urgent surgery.</p>
<p><strong>Results.</strong> Vertical tubular resection of the stomach with splenectomy with impossible endoscopic hemostasis eliminates the risk of gastric bleeding in oncohematological patients and saves the patient's life.</p>
<p><strong>Summary.</strong> This clinical observation demonstrates the relevance of timely surgical treatment of patients with bleeding from varicose veins of the stomach. Vertical tubular resection of the stomach along with splenectomy allows to exclude the risk of bleeding in this group of patients in the future.</p>vertical tubular resection of the stomach, splenectomy, bleeding of varicose veins of the stomach, splenic vein thrombosis, portal hypertension.Вертикальная трубчатая резекция желудка, спленэктомия, кровотечение из варикозно расширенных вен желудка, тромбоз селезеночной вены, портальная гипертензия.[Savchenko VG. Diagnostika i terapiya ph-negativnykh mieloproliferativnykh zabolevanii (istinnaya politsitemiya, essentsial'naya trombotsitemiya, pervichnyi mielofibroz): klinicheskie rekomendatsii. M. 2014; 81.(in Russ.)][Ozsay O. Hydatid cyst of the pancreas causing both acute pancreatitis and splenic vein thrombosis. Ann R Coll Surg Engl. 2018; 100 (7):178-180.][Morbieu C. Systematic detection of portal or splenic vein thrombosis after splenectomy for immune cytopenia. Am J Hematol. 2018; 93 (7): 1-3.][Alshreadah S, Alotaibi R, Aldabaeab A, Alhafid I. Thrombosis of the spleno-mesentiric portal axis following laparoscopic sleeve gastrectomy: A rare case report. Int J Surg Case Rep. 2018; 43: 29-31.][Kuroki T. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today. 2018; 48 (8): 804-809.][Gouin B. Splanchnic vein thrombosis. Rev Med Suisse. 2017; 13 (586): 2138-2143.][Franco-Avilés L. Segmental portal hypertension with splenic vein thrombosis caused by pancreatitis. Rev Med Inst Mex Seguro Soc. 2017; 55 (60): 788-790.][Shoar S. Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients. Surg Obes Relat Dis.2018; 14 (1): 47-59.][de'Angelis N. Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy. Surgery. 2017; 162 (6): 1219-1230.][Pearl Princess D. Vascular Diseases of the Spleen: A Review. J Clin Transl Hepatol. 2017; 5 (2): 152-164.][Tefferi A. Splenectomy in myelofibrosis with myeloid metaplasia: a single-institution experience with 223 patients. Blood. 2000; 95(7): 226-2233.][Köklü S. Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study. Dig Dis Sci. 2005; 50: 976–982. ]