Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 1024-1028
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1024
Gastric cancer with severe immune thrombocytopenia: A case report
Zhe-Wei Zhao, Wei-Ming Kang, Zhi-Qiang Ma, Xin Ye, Jian-Chun Yu
Zhe-Wei Zhao, Wei-Ming Kang, Zhi-Qiang Ma, Xin Ye, Jian-Chun Yu, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhao ZW and Yu JC drafted this manuscript; Kang WM and Yu JC performed the operation for this patient; Ma ZQ and Ye X analyzed the patient data and prepared the figures; all authors read and approved the final manuscript.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Chun Yu, MD, Chief Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. yjcpumch@126.com
Telephone: +86-10-69155067 Fax: +86-10-69155068
Received: August 16, 2018
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
Processing time: 113 Days and 1.5 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.

Keywords: Gastric cancer; Immune thrombocytopenia; Surgical treatment; Case report

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.