Liječnički vjesnik, Vol. 147 No. 5-6, 2025.
Stručni rad
https://doi.org/10.26800/LV-147-5-6-6
Acute abdomen following splenic embolization due to immune thrombocytopenia – a case report
Mark Žižak
orcid.org/0009-0005-2140-0147
*
Višnja Nesek Adam
orcid.org/0000-0002-6521-4136
Sanja Berić
orcid.org/0009-0002-5000-6470
Ranko Smiljanić
* Dopisni autor.
Sažetak
A 56-year-old female patient was hospitalized due to severe thrombocytopenia manifested by epistaxis, gum bleeding, and skin hematomas. She has been treated for immune thrombocytopenia (ITP) for over 10 years and has previously responded successfully to glucocorticoids, intravenous immunoglobulins, and hydroxychloroquine. Upon admission to the hematology department, treatment with immunosuppressive and thrombopoietic therapy was initiated. Since there was no response, intravenous immunoglobulins (IVIG) were reintroduced, resulting in a transient increase in platelet count to 57x109/L, but the effect lasted only three days. Considering it was thrombocytopenia refractory to conservative treatment, a surgeon was consulted regarding splenectomy. Due to the risk of bleeding during the procedure, the surgeon recommended splenic embolization as a less invasive treatment method. The embolization procedure went smoothly, but later the patient’s general condition deteriorated due to the development of peritonitis. Intraoperatively, gastric necrosis and perforation were found, and splenectomy and resection of the necrotic part of the stomach were performed. The postoperative course was complicated by respiratory complications and a recurrent drop in platelet count, which required additional platelet transfusions and IVIG administration. Due to recurring abdominal pain, continuous drain output, and the development of pneumoperitoneum, another surgical intervention was indicated. Since abdominal drainage did not decrease after the revision procedure, a follow-up MSCT verified a narrow gastric fistula, which was managed gastroscopically by occlusion with a metal clip. Subsequently, the drainage decreased, the patient was gradually introduced to enteral nutrition which she tolerated well, and she was discharged home after a total of 95 days of teratreatment. This case highlights the complexity of treating refractory ITP and the importance of early recognition and management of post-embolization complications.
Ključne riječi
PURPURA, THROMBOCYTOPENIC, IDIOPATHIC – therapy; EMBOLIZATION, THERAPEUTIC – adverse effects; PERITONITIS – etiology; NECROSIS – etiology, surgery; GASTRIC RUPTURE – etiology, surgery; GASTRIC FISTULA – etiology, surgery; SPLENECTOMY
Hrčak ID:
333345
URI
Datum izdavanja:
10.7.2025.
Posjeta: 552 *