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      Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura

      case-report

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          Abstract

          Situs inversus totalis is a rare congenital abnormality with mirror symmetry of mediastinal and abdominal organs. Immune thrombocytopenic purpura is an autoimmune disease with destruction of thrombocytes. This paper is presentation of surgical approach to a case with coexistence of these two conditions.

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          CT features of the accessory spleen.

          Bart Mortelé, S. Silverman, K Mortelé (2004)
          The purpose of this study was to describe the prevalence and CT features of the accessory spleen. Accessory spleens are present in 16% of patients undergoing contrast-enhanced abdominal CT. Typically, accessory spleens appear on CT scans as well-marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images. When accessory spleens are smaller than 1 cm, their attenuation may be lower than that of the spleen because of partial volume effects. Their most frequent location (22%) is posteromedial to the spleen; anterolateral to the upper pole of the left kidney; and lateral, posterior, and superior to the tail of the pancreas. Familiarity with these characteristic features may differentiate them from other pathologic findings in the upper abdomen.
          Article 0 comments Cited 51 times – based on 0 reviews     Review now
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            Is Open Access

            Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report

            Bessy S. Flores-Chang, Carlos E. Arias-Morales, Francis G Wadskier … (2015)
            Immune thrombocytopenic purpura (ITP) is defined as an acquired thrombocytopenia with antibodies detected against platelet surface antigens, and it is the most common form of thrombocytopenia in otherwise asymptomatic adults. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish for treatment efficacy. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common; however, case reports associated with diagnosis in immunocompetent adults are rare, and to the best of our knowledge only 20 publications have been associated with this diagnosis. Our report is based on a clinical presentation of a 37-year-old female complaining of petechiae, heavy menses, shortness of breath, and a platelet count of 1 × 109/L. Treatment with IVIG and steroids failed to improve platelet count. Subsequently, an infectious laboratory workup was performed, detecting CMV infection, and treatment with antiviral agents was initiated, causing platelet count to increase as viral load decreased.
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              Predictive factors of response to splenectomy in adult chronic idiopathic thrombocytopenic purpura.

              R Vecchio, E Cacciola, R R Cacciola … (2015)
              A total of 26 surgical patients with chronic idiopathic thrombocytopenic purpura (ITP) were reviewed and results of splenectomy were statistically related to age and sex, length of and response to pre-operative corticosteroid therapy, pre-operative platelet count and time interval between diagnosis and surgery. Median age was 37 years (range, 17-81 years) and the male:female ratio was 1.16. Pre-operative platelet count ranged from 2-70 x 10(9)/l. The length of pre-surgical corticosteroid therapy (prednisone 1-2 mg/kg/day) varied from 2 weeks to 3 years. Steroid therapy was unsuccessful in 15 patients and only achieved temporary remission in the remaining 11 cases. The time interval between diagnosis and splenectomy ranged from 4-60 months. There were 21 responders (80.4%) and 5 non-responders (19.6%) to splenectomy. Using the chi-square test, differences in age, length and response to pre-operative steroid therapy and diagnosis-to-splenectomy interval did not achieve statistical significance when responder and non-responder groups to splenectomy were compared. Conversely, a significant difference was found comparing male to female groups, since 92.9% of males and only 66.7% of females were successfully treated by surgery (P approximately 0.01). In addition, patients with a pre-operative platelet count less than 30 x 10(9)/l responded at an higher rate (100% versus 70.6%; P approximately 0.05) to splenectomy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Surg
                Journal ID (iso-abbrev): Case Rep Surg
                Journal ID (publisher-id): CRIS
                Title: Case Reports in Surgery
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6900
                ISSN (Electronic): 2090-6919
                Publication date (Print): 2016
                Publication date (Electronic): 14 February 2016
                Volume: 2016
                Electronic Location Identifier: 8605673
                Affiliations
                1Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
                2Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
                Author notes

                Academic Editor: Christoph Schmitz

                Article
                DOI: 10.1155/2016/8605673
                PMC ID: 4769751
                PubMed ID: 26981307
                SO-VID: b510da2b-225a-4b82-9d89-8163885d09b6
                Copyright © Copyright © 2016 Kemal Gundogdu et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 December 2015
                Date accepted : 12 January 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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