Successfully Completed Laparoscopic Splenectomy for Young Woman With Immune Thrombocytopenic Purpura During Pregnancy in Reduced Port Surgery: A Case Study

Abstract

Immune thrombocytopenic purpura (ITP) during pregnancy is a rare condition; however, it can lead to hemorrhagic complications due to gestational thrombocytopenia during delivery. A splenectomy is the treatment that will result in the highest complete remission rate for ITP and is sometimes required when thrombocytopenia is severe and fails to respond to medical treatment. Herein, we present a case of a patient who underwent a reduced port laparoscopic splenectomy (RPLS) for ITP during pregnancy. A 33-year-old female patient, who had past history of miscarriage at the 12th week of gestation and a stillbirth at the 36th week of gestation, was diagnosed with ITP at the 12th week of gestation. The patient received medical treatment, but the platelet count did not increase enough for spontaneous delivery. Therefore, a 3-port RPLS was scheduled at the 20th week of gestation following treatment with high-dose immunoglobulin therapy for 5 days. The patient was placed in the right semilateral position. The pneumoperitoneal pressure was set at 8 mmHg, which is lower than that used in a typical operation. The overall procedures were similar to those of a 4-port technique. There was no change in the fetal heart rate during or after the operation. The platelet counts increased and were maintained after the RPLS, and the course of the pregnancy was successful. The patient was able to deliver a healthy infant via vaginal delivery at the 37th week of gestation. In our experience, RPLS procedures offer high cosmetic satisfaction and are feasible and safe during the second trimester in pregnant women with ITP that does not respond well to medical treatments.