Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1024
Peer-review started: August 17, 2018
First decision: October 8, 2018
Revised: October 31, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 6, 2018
Primary immune thrombocytopenia (ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, we present the first case of gastric cancer with severe and medically refractory ITP treated by radical resection of the gastric cancer and splenectomy.
A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient’s complication of severe and medically refractory ITP.
Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.
Core tip: Immune thrombocytopenia (ITP) is a rare autoimmune disease with a reduced platelet count. Severe and medically refractory thrombocytopenia is an absolute contraindication to chemotherapy or radiotherapy. For those patients with a malignant tumor, surgical treatment may be the only option despite a high risk of bleeding. This case might contribute to improving our understanding of the behavior and perioperative management of severe and medically refractory ITP patients with gastric cancer.