An 87-year-old male patient known to have polycythemia vera presented at the hospital as an acute abdominal emergency. Ultrasonography of the abdomen revealed a homogeneous echogenic mass measuring 22 × 15 × 8 cm in fascial planes anterior to the peritoneum, which was consistent with a hematoma. His platelet count was 937,000/mm3. The patient responded to plateletpheresis and supportive management. Older patients with polycythemia vera may present as acute abdomen secondary to spontaneous abdominal wall hematoma. Computerized tomography or ultrasonography of the abdomen can aid in making the diagnosis and preventing unnecessary surgical intervention.

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