Brief description of the case: Male, 49 years old, hospitalization number 4426612. Chief complaint: persistent epigastric pain for more than 20 days with fever. History: The patient had sudden onset of epigastric pain with no obvious cause more than 20 days ago, with paroxysmal intensification, no nausea and vomiting, and reduced exhaustion and defecation. 3 days ago, the abdominal pain was significantly aggravated and the body temperature gradually increased. Physical examination on admission: T39oC, total abdominal tenderness, diminished bowel sounds, significant pressure pain and rebound pain in the left upper abdomen, splenomegaly of degree II, evidence of ascites (-). CT (outside hospital) showed: extensive thrombosis of portal venous system with possible splenic infarction. Emergency ultrasound showed: portal vein embolism with hypoechoic area in the spleen. Laboratory tests: coagulation: PLT 15.2 seconds, APTT 45.1 seconds, FIB 4.9g/l; hepatitis complete set: HBsAb 334.45mIU/ml, HBcAb
9.21S/CO; biochemistry: ALB 33.1g/L; A/G 1.26; glutamyl transpeptidase 60.5U/L; LDH 306U/L; CRP 67.7mg/L; blood routine: Hb
117g/L, WBC 20.9 10*9/L; N 81.3%; PLT 809 10*9/L. Admission diagnosis: 1. extensive thrombosis of the portal venous system 2. possible splenic infarction. Treatment: Vascular surgery performed routine anti-infection, anticoagulation and other symptomatic treatment for three days, abdominal pain was not relieved, body temperature was flaccid fever type, and emergency consultation was requested from the general surgery portal hypertension specialty group. Two days after the referral, subacute surgery was performed under general anesthesia. Intraoperative findings: clear and bright ascites of 500 ML, significant thrombosis in the gastric omental vessels, large omentum completely wrapping the spleen, FPP 36 cmH2O, superior pole of the spleen and large infarct foci with a large amount of necrotic tissue inside, exploration revealed thick gastric perforating branches, esophageal branches, and high esophageal branches, splenectomy and selective flow dissection were performed. See attached photos. The postoperative recovery was smooth and he was discharged 17 days after surgery without fever, no ascites, normal blood biochemistry, but platelets were up to about 3 million, while the coagulation triad was normal. Follow-up visit (2012-08-10): platelets 1.98 million, white blood cells 12,000, coagulation five normal, no discomfort, no ascites, has resumed physical work. Follow-up visit (2013-12-04): no discomfort, no ascites, moderate physical labor, normal blood count and biochemistry.