Life-threatening hemorrhagic shock after laparoscopic surgery: a case of postoperative thrombotic thrombocytopenic purpura

Abstract

We report the successful management of a female patient who developed postoperative thrombotic thrombocytopenic purpura (TTP) after an uneventful laparoscopic oophorocystectomy. The patient underwent uneventful laparoscopic surgery for ovarian cystoma. One hour after completion of surgery, the patient suddenly went into shock, with her blood pressure dropping to 60/40 mmHg. Hemorrhage into the abdominal cavity with an estimated blood loss of 2,000 ml was confirmed by exploratory laparotomy. Initially, anemia and thrombocytopenia were attributed to blood consumption or disseminated intravascular coagulation (DIC). However, blood tests revealed evidence of hemolytic anemia, with fragmented erythrocytes observed on peripheral blood smear examination. Serum levels of lactate dehydrogenase, blood urea nitrogen, and creatinine were elevated. Based on the findings, postoperative TTP was suspected. High-dose steroids and plasma infusions were administered but proved ineffective. Plasma exchange was performed three times, resulting in resolution of postoperative TTP. TTP is an idiopathic disorder, known to be triggered by surgical trauma. Postoperative TTP is difficult to distinguish clinically from DIC because of its close similarity with the latter and subtle differences from other postoperative hematological complications. It is important to bear in mind the possibility of postoperative TTP in patients with unexplained hemorrhagic shock after uneventful surgery.

Postsurgical thrombotic microangiopathy: Case series and review of the literature

“…Cardiovascular surgeries were the most common procedure provoking TMA with coronary artery bypass grafts (CABG) [14][15][16][17][18] or a combination of CABG with another vascular procedure being the second most common. 14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of TMAs occurring after abdominal surgery, 26,[31][32][33][34][35][36][37] bowel resection accounted for the most common preceding procedure (n = 6). 17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures.…”

Thrombotisch-thrombozytopenische Purpura nach Zirkumzision

“…1). Charakterisiert ist das klinische Erscheinungsbild durch das Auftreten einer schweren Thrombozytopenie, einer hämolytischen Anämie, Fieber und häufig Organmanifestationen wie Niereninsuffizienz oder neurologischen Defiziten [1,[3][4][5].…”