6) Surgery
Two main complications occur due to polycythemia which need surgical treatment: splenic enlargement and Budd-Chiari syndrome. Splenic enlargement or splenomegaly can be troublesome if the spleen reaches a large size causing discomfort in the upper abdomen which is usually felt as heaviness. Also, due to the high probability of thrombus formation, splenic infarction can occur, causing sharp pain that may be repeated on several episodes.
Budd-Chiari syndrome is the obstruction of the hepatic veins draining the liver into the inferior vena cava and to the heart. It causes pain, abdominal enlargement due to ascites and liver enlargement. The condition is treated by the use of shunts to bypass the obstruction namely Trans jugular intrahepatic portosystemic shunt (TIPS), Side-to-side portocaval shunt or portocaval/cavoatrial shunt.