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What treatment do you advise for an enlarged spleen with thrombosis?

Q: This is in reference to a condition called Splenomegaly with thrombosis in portal vein which was observed in my sister-in-law (27 years old), after conducting colour Doppler scan test. The consulting doctor is suggesting an operation, is there any other method of treatment? I also want to know if there are any ill effects after the operation and what are her chances of recovery? In Doppler scan test the liver was shown to be normal with little hint of shrinkage. Actually last week she had blood vomiting. When she consulted the doctor he suggested a blood test and it was found that her haemoglobin was 3.0g/dl. He advised blood transfusion but before that the doctor wanted to know the cause for such a low level. Then he conducted some other tests-serum iron, HBsAg, bone marrow etc-and they were found to be normal. During endoscopy it was suspected that she had portal hypertension and after the test it was found that she had splenomegaly with portal thrombosis. So please suggest.

A:In the case of your sister-in-law the condition is called extra-hepatic portal hypertension. There is risk of blood vomiting in the long term. Also since her spleen is enlarged problems like anaemia which you have mentioned are likely to recur. However the treatment is not only splenectomy but some other procedure like a shunt or a non-shunt operation for treating both the enlarged spleen and the portal hypertension at the same time. Splenectomy alone would leave the portal hypertension and the risk of bleeding from the gullet untreated. At her age the risk of the surgery is low. There are also other options without surgery to treat the risk of bleeding which can be combined with a splenectomy. I advise you to consult a gastroenterologist for advice in this matter.

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