Polycythemia vera (PV) is classified as a myeloproliferative disorder (MPD). Such patients are prone to both thrombotic and hemorrhagic events. Although gastrointestinal (GI) bleeding is not a prominent manifestation of PV, it would be life threatening and necessitating hospital admission and blood transfusion if it occurs. GI hemorrhage in these patients may be due to Aspirin usage, peptic ulcer disease (PUD), acquired Von Willbrand disease, Dieulafoy lesion (DL), Mallory Weiss tear, and esophageal and gastric varices. In this case report, we describe a 65-year-old man with history of PV presented with a massive upper GI bleeding. After a therapeutic endoscopic hemostasis failure and reoccurrence of bleeding during hospital admission, an abdominal computed tomography (CT) was ordered, which revealed an aberrant artery originated from aorta directly into the stomach. An angiographic embolization was considered for the patient, which was successfully performed.
Abdominal CT Scan revealed an aberrant artery originated from the celiac artery that was piercing into the fundus of stomach. Evidently, fundal oozing was attributed to a Dieulafoy lesion. Above that an old splenic arterial thrombosis and multiple collateral arteries around the pancreas were seen (figures 1, 2, 3, and 4). Portal and splenic veins were patent and were found without thrombosis. No evidence of left sided portal hypertension was detected in the angiogram (figure 5). The patient underwent celiac and mesenteric angiographic embolization with three vials of polyvinyl alcohol (PVA). There was no active bleeding from left gastric artery.
Our patient was complicated by splenic infarction due to splenic collateral arteries embolization and the overwhelming thrombotic tendency of the patient himself due to the history of PV. Fortunately, our patient’s signs and symptoms responded to supportive therapies and eventually he discharged well.