title: Subtotal laparoscopic splenectomy and esophagogastric devascularization for the thrombocytopenia because of portal cavernoma--case report.
abstract: An 8-year-old girl presented with a history of pain in the right hypocondrium, multiple petechiae in the skin, and ecchimoses at sites of minor trauma. Laboratory investigations showed severe thrombocytopenia. Doppler ultrasonography and magnetic resonance imaging showed portal and splenic vein cavernomatous transformation and splenomegaly. The patient underwent laparoscopic subtotal splenectomy with lower pole preservation and esophagogastric devascularization. The postoperative course was uneventful. No gastrointestinal bleeding occurred within the first 34 months after surgery.
  
  
  CONCLUSIONS
  Thrombocytopenia associated with splenomegaly is a rare form of presentation in portal cavernoma. Preserving the spleen immune function must be a goal in surgical management, especially in children. Laparoscopic subtotal splenectomy combined with esophagogastric devascularization is a difficult procedure, but it can be useful in patients with portal cavernoma and severe thrombocytopenia without gastrointestinal bleeding.
authors.affiliation: Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. catvasilescu@gmail.com
authors.forename: Catalin
authors.initials: C
authors.lastname: Vasilescu
authors.forename: Oana
authors.initials: O
authors.lastname: Stanciulea
authors.forename: Monica
authors.initials: M
authors.lastname: Popa
authors.forename: Anca
authors.initials: A
authors.lastname: Colita
authors.forename: Constantin
authors.initials: C
authors.lastname: Arion
mesh_terms: D002648:Child; D004943:Esophagogastric Junction / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D011169:Portal Vein; D013156:Splenectomy; D013162:Splenic Vein; D013921:Thrombocytopenia / Q000601:surgery*; D014652:Vascular Diseases / Q000601:surgery*; D014656:Vascular Surgical Procedures