Life-Threatening Massive Thromboembolism After Laparoscopic Splenectomy in an Idiopathic Thrombocytopenic Patient

Authors

  • B. Uz Department of Hematology, Firat University School of Medicine, Elazig, Turkey
  • D. Duzenci Department of Internal Medicine, F?rat University School of Medicine, Elazig, Turkey
  • H. Atli Department of Internal Medicine, F?rat University School of Medicine, Elazig, Turkey
  • B. Karakaya Department of Internal Medicine, Firat University School of Medicine, Elazig, Turkey
  • M. R. Onur Department of Radiology, Firat University School of Medicine, Elazig, Turkey
  • E. Aygen Department of Surgery, Firat University School of Medicine, Elazig, Turkey

DOI:

https://doi.org/10.15379/2408-9877.2014.01.01.3

Keywords:

Portal vein thrombosis, Anticoagulation, Low molecular weight heparin.

Abstract

A life-threatening massive thromboembolism is reported that developed after laparoscopic splenectomy in a 57-year-old female with idiopathic thrombocytopenic purpura (ITP). Although asymptomatic, she underwent splenectomy because of poor response to steroids and intravenous (IV) gamma globulin. Thirteen days after splenectomy, she suffered portal and mesenteric emboli, followed by pulmoner emboli and left popliteal thrombophlebitis. Extensive workup for hypercoagulable states was negative. Low molecular weight heparin (LMWH) was initiated at a suboptimal dose because of thrombocytopenia. During follow-up, her platelet count increased gradually. Whenever the platelet count had remained stable at > 50 x 109/L, she received full dose of LMWH treatment. Over the next 38 days, her pain resolved, she tolerated a full diet, and sent home. Follow-up imaging studies demonstrated a recanalized portal vein and totally resolved pulmonary arteries. We thought that, consumption of platelets in the massive thromboembolism sites including portal, mesenteric and pulmoner vascular beds had resulted in deep thrombocytopenia, which improved gradually with anticoagulant therapy.

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Published

2014-08-21

Issue

Vol. 1 No. 1 (2014)

Section

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