Acute Ulcerative Colitis, Thrombocytopenia, and Venous Thromboembolism Treated With Combined Laparoscopic Splenectomy and Colectomy

Ahmed Dehal, MD, MPH, Sunal Patel, MD, Samir Johna, MD, Patrick Nguyen, MDDepartment of General Surgery, Kaiser Permanente, Fontana, CA, USA (all authors).

ABSTRACT

Immune thrombocytopenic purpura and venous thromboembolism are rare but known complications of ulcerative colitis. Although several case studies have examined the treatment options available for ulcerative colitis patients presenting with immune thrombocytopenic purpura, there have been no reported cases that describe the optimal treatment for patients with ulcerative colitis and immune thrombocytopenic purpura complicated by simultaneous deep venous thromboses. We present the case of a 19-year-old woman who presented with ulcerative colitis and immune thrombocytopenic purpura and in whom multiple deep venous thromboses also developed. The patient underwent urgent simultaneous laparoscopic colectomy and splenectomy. She improved clinically, and her platelet count recovered after surgery. When thrombocytopenia develops in patients with ulcerative colitis, a diagnosis of immune thrombocytopenic purpura should be considered. In such patients, pre-existing ulcerative colitis might be involved in the immunologic causal mechanism of immune thrombocytopenic purpura and venous thromboembolism. In cases in which these entities are refractory to medical management or complicated by venous thromboembolism, simultaneous laparoscopic colectomy and splenectomy are safe and well tolerated and can be lifesaving.