title: Results of emergency surgery in patients with Moschowitz's disease refractory to hematological treatment: is splenectomy always advisable?
abstract: BACKGROUND
  Patients with thrombotic thrombocytopenic purpura (TTP), Moschowitz's disease, run a high risk of perioperative bleeding and need intensive hematologic support. In some patients, TTP is associated with cancer but the surgical role in these patients is still unclear. To illustrate the surgical problems and outcome we present the case histories of three patients with TTP observed in our emergency department.
  
  
  METHODS
  Two patients had TTP secondary to cancer and one patient with primary TTP (no evidence of neoplasia) had emergency operation for gastric hemorrhage, occlusion and TTP unresponsive to plasmapheresis.
  
  
  RESULTS
  The first two patients who had not radical resection of cancer and no splenectomy, died for TTP complications. The third patient who underwent emergency splenectomy, had an uneventful postoperative course and TTP completely regressed.
  
  
  CONCLUSIONS
  These case reports suggest that patients with TTP should be screened to rule out cancer. In patients with acute cancer-related complications emergency surgery should aim to resect the cancer. An associated splenectomy may increase the effectiveness of postoperative hematologic therapy.
authors.affiliation: Istituto Dipartimentalizzato di Chirurgia d'Urgenza e di Pronto Soccorso, Cattedra di Chirurgia d'Urgenza II.
authors.forename: R
authors.initials: R
authors.lastname: Caronna
authors.forename: M
authors.initials: M
authors.lastname: Cardi
authors.forename: G
authors.initials: G
authors.lastname: Meloni
authors.forename: S
authors.initials: S
authors.lastname: Mangioni
authors.forename: G
authors.initials: G
authors.lastname: Spera
authors.forename: M
authors.initials: M
authors.lastname: Benedetti
authors.forename: V
authors.initials: V
authors.lastname: Frantellizzi
authors.forename: D
authors.initials: D
authors.lastname: Layek
authors.forename: S
authors.initials: S
authors.lastname: Catinelli
authors.forename: M
authors.initials: M
authors.lastname: Schiratti
authors.forename: P
authors.initials: P
authors.lastname: Chirletti
mesh_terms: D000328:Adult; D003663:Decision Trees; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000601:surgery*; D012307:Risk Factors; D013156:Splenectomy