Posters: Surgery Curr Res
Background: Immune thrombocytopenic purpura (ITP) and venous thromboembolism (VTE) are rare but known complications of ulcerative colitis (UC). We present a case of UC and ITP who also developed multiple deep venous thromboses (DVTs). While several case studies have examined the treatment options available for ulcerative colitis presenting with ITP, there have been no reported cases that describe the optimal treatment for patients with UC and ITP complicated by simultaneous DVTs. Case report: A 19 years old female presented with acute UC flare up based on clinical features and endoscopic appearance. On admission, the patient was started on 5-ASA and steroids. Tendency for thrombocytopenia was observed early in the course of hospitalization prior to drug administration. Despite the cessation of medications, severe worsening thrombocytopenia was noted. Immune thrombocytopenic purpura (ITP) was suspected based on positive autoantibody to platelet membrane antigen and the absence of splenomegaly. Medical treatment, including increased dosage of steroids, failed to control UC and acute thrombocytopenia and patient continued to have worsening hematochezia. Moreover, the patient developed multiple DVTs and anticoagulation could not be started due to bleeding. The patient underwent urgent simultaneous laparoscopic colectomy and splenectomy. The patient clinically improved and the platelet count recovered after surgery. Conclusion: When patients with UC develop thrombocytopenia, a diagnosis of ITP should be considered. In such patients, pre-existing UC might be involved in the immunological causal mechanism of ITP and VTE. In cases where these entities are refractory to medical management or complicated by occurrences of VTE, simultaneous colectomy and splenectomy can be life savin
Ahmed Dehal has completed his medical training at the age of 24 years from University of Baghdad in Baghdad, Iraq. He has also received a Masters degree in Epidemiology/Clinical Research from Georgia Southern University in Georgia, United States. He has then joined Kaiser Permanente (Fontana) general surgery residency program in California, United States. He is currently in his third year of training. He has published 8 papers in reputed journals during his residency so far.