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A 70-year-old woman, who had hepatitis-C related liver cirrhosis died suddenly. Autopsy showed a massive retroperitoneal hematoma and ruptured splenic vein, as well as densely bloody ascites. This suggested that chronic and unnoticed retroperitoneal leak from the ruptured vein preceded the acute and fatal outcome of the intra-abdominal bleeding. Spontaneous rupture of the splenic vein is rarely reported in liver cirrhosis despite the presence of portal hypertension. This rare association is discussed with a literature review.
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