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From question on page 1278
The diagnosis was splenic infarction secondary to idiopathic splenic vein thrombosis. The patient was treated with intravenous heparin for six days. Following resolution of abdominal pain and tenderness, she was converted to oral warfarin therapy. Computed tomography scan three months later demonstrated a normal spleen with complete resolution of splenic oedema and pulmonary consolidation. The splenic vein was attenuated and ill defined, with evidence of collateral vessel formation. The patient made a full clinical recovery.
The principal challenge in this case was the choice of conservative treatment versus splenectomy to avert rupture. While splenectomy appears to be an effective treatment in splenic vein thrombosis, it incurs the cost of a lifelong requirement for prophylactic antibiotic therapy. Our patient represents successful management of splenic vein thrombosis by anticoagulation, of which there are only a few reported cases in the literature.
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