A Case of Severe Thrombocytopenia after Laparoscopic Cholecystectomy with Diagnostic Difficulties

DOI Web Site 21 References
  • Nakamura Sota
    Department of Surgery, Fukuoka City Hospital Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Morita Kazutoyo
    Department of Surgery, Fukuoka City Hospital
  • Ninomiya Mizuki
    Department of Surgery, Fukuoka City Hospital Department of Surgery, Aso Iizuka Hospital
  • Yamamoto Manabu
    Department of Surgery, Fukuoka City Hospital
  • Higashi Hidefumi
    Department of Surgery, Fukuoka City Hospital
  • Terasaki Fumie
    Department of Pharmacy, Fukuoka City Hospital
  • Kurata Yasuo
    Department of Pharmacy, Fukuoka City Hospital
  • Itoh Shinji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yoshizumi Tomoharu
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 診断に苦慮した腹腔鏡下胆囊摘出術後の重症血小板減少の1例
Published
2025-06-01
DOI
  • 10.5833/jjgs.2024.0072
Publisher
The Japanese Society of Gastroenterological Surgery

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<p>An 86-year-old man was admitted with acute cholecystitis and developed cholangitis due to choledocholithiasis. He initially received antibiotic therapy and endoscopic treatment, and subsequently developed portal vein thrombosis, for which anticoagulant therapy was initiated. He was discharged temporarily. On the 37th day after the first admission, he underwent elective laparoscopic cholecystectomy. On postoperative day (POD) 3, his platelet count dropped sharply to 1,000/μl. There were no signs of postoperative bleeding, sepsis, hemolysis, or progression of portal vein thrombosis. Drug-induced thrombocytopenia was considered as a differential diagnosis. Despite daily platelet transfusions, there was no response, and his platelet count fell to 0/μl on POD 4. Intravenous immunoglobulin therapy was initiated on POD 6, after which his platelet count gradually increased. He was discharged on POD 13 without severe bleeding events. Cefotiam and acetaminophen were suspected as possible causative agents, since both were administered pre- and postoperatively. Postoperative thrombocytopenia is a rare complication that surgeons may encounter, but severe thrombocytopenia can lead to life-threatening bleeding, necessitating prompt diagnosis and intervention.</p>

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