Laparoscopic accessory splenectomy in recurrent chronic immune thrombocytopenic purpura.
Splenectomy is the definitive treatment for most cases of idiopathic thrombocytopenic purpura (ITP). We present the case of a patient who was discovered to have ITP at age 5 and was treated medically for 3 years with decreasing response to medication. At age 8, he underwent splenectomy, after which the platelet count stabilized at approximately 200,000/mm3. Two years later he again had symptoms of thrombocytopenia and was treated medically with moderate success. At age 12, during hospitalization for bleeding, his liver/spleen scan gave negative results. Symptoms persisted, and when the patient was 13 a second scan found two small areas of uptake in the area of the splenic bed suggestive of secondary accessory splenic activity. The platelet count at that time was 6,000/mm3. Laparoscopy was performed, and after careful dissection of the left-upper quadrant, two globular masses, the larger of which was 3 x 2 x 2 cm, were removed without incident. The latest platelet count, 3 months after laparoscopic secondary accessory splenectomy, was 169,000/mm3, and a follow-up scan shows no uptake in the area of the spleen.
Rogers
J
J
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Yousuf
A
A
Kleinhaus
S
S
D002675:Child, Preschool; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000000981:diagnostic imaging / Q000601:surgery*; D011877:Radionuclide Imaging; D012008:Recurrence; D012086:Reoperation; D013154:Spleen / Q000000981:diagnostic imaging / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*