Vaginal Bleeding As The Presenting Manifestation of Post-Hepatectomy/-Splenectomy Portal-Mesenteric Venous Thrombosis

Background: Portal-mesenteric venous thrombosis is not uncommon after hepatectomy or splenectomy but is under-recognized because of non-specific symptoms and lack of awareness of the clinicians. However, misdiagnosis or delayed treatment may have fatal consequences. Case Presentation: A 57-year-old menopausal woman with the medical history of hepatocellular carcinoma, stage I, underwent laparoscopic partial hepatectomy (S4) and splenectomy 2 months before the presentation of progressive vaginal spotting and vague abdominal pain. Dysfunctional uterine bleeding was suspected initially, but subsequent contrast-enhanced computed tomography due to concern for post-procedure complications revealed thrombosis in the portal vein and superior mesenteric vein. The patient received anticoagulant therapy, and her symptoms gradually resolved. Conclusions: : To the best of our knowledge, vaginal variceal bleeding secondary to portal-mesenteric venous thrombosis has never been reported, but it can be the presenting manifestation for this condition. It should be considered in the differential diagnosis of patients who present with vague abdominal symptoms after hepatectomy or splenectomy.