David J Berler, MD, Jessica Gonzalez-Hernandez, MD, Sara A Hennessy, MD, FACS. UT Southwestern Medical Center
Immune thrombocytopenic purpura affects up to 2 in 10,000 pregnancies and can lead to devastating, potentially life-threatening peripartum hemorrhage. Treatment with corticosteroids and/or IV immunoglobulin is often effective. For those who fail medical therapy and are found to have significant thrombocytopenia (<30,000 in the presence of bleeding complications, or <10,000 irrespective of the presence of bleeding complications) splenectomy should be considered. 90% of patients will experience a sustained rise in platelet count following this intervention. A laparoscopic approach should be considered, as it is safe, cosmetic, and associated with shorter hospital stays and less surgical morbidity than open splenectomy. During the second trimester, such an approach is also technically feasible and mitigates the risks of preterm labor and spontaneous abortion. We present the case of a 20-year-old woman at 27 weeks gestation with severe, medically refractory ITP and a platelet count of 3000, which promptly increased following laparoscopic splenectomy. Her postoperative course was without complications and she was discharged home on postoperative day three. This patient ultimately delivered a term infant with no peripartum bleeding complications, illustrating the efficacy of this treatment for this disease process in this patient population. A recently published set of SAGES guidelines regarding the use of laparoscopy during pregnancy is reviewed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94830
Program Number: V127
Presentation Session: Solid Organ Videos
Presentation Type: Video