title: Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: a case report.
abstract: A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases. Blood routine test showed a leukocyte count of 22.74 × 10(9)/L, with 91.4% neutrophils, and a platelet count of 4 × 10(9)/L before admission. The case question was whether the team should proceed with surgery. Obviously, a differential diagnosis is essential before making such a decision. Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 10(9)/L and the result of abdominal computed tomography scan. However, it was not clear whether the severe thrombocytopenia was primary or secondary. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases. Neither of the tests indicated obvious pathological hematological changes. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Zhang
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Guo-Li
authors.initials: GL
authors.lastname: Gu
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Zhang
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Fan
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Xin-Yan
authors.initials: XY
authors.lastname: Wang
authors.affiliation: Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Xue-Ming
authors.initials: XM
authors.lastname: Wei
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001856:Bone Marrow Examination; D000075202:Contraindications; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Appendectomy; Appendicitis; Fever; Infection; Thrombocytopenia