Clinical Case of Tubular Gastrectomy and Splenectomy, the Bleeding from Vericose Veins of the Stomach and Splenomegaly in the Background Idiopathic Myelofibrosis in Urgent Surgery

Abstract

Relevance. 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.
 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.
 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.
 The aim 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.
 Materials and methods. 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.
 Results. 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.
 Summary. 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.