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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Combined caesarean with splenectomy in pregnancy with portal hypertension: defining plausibility
  1. Manjunath Maruti Pol1,
  2. Latika Uniyal Chawla2,
  3. Yashwant Singh Rathore1,
  4. Ritesh Goel1
  1. 1Department of Surgical Disciplines (General Surgery), All India Institute of Medical Sciences, New Delhi, Delhi, India
  2. 2Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Manjunath Maruti Pol, manjunath.pol{at}gmail.com

Summary

24-year-old woman at 28 weeks gestation was referred from peripheral hospital with diagnosis of pregnancy with portal hypertension. She had received multiple transfusion for pancytopaenia in the past and had undergone endoscopic sclerotherapy for oesophageal varices. Initially, she was admitted in our hospital at 28 weeks gestation for blood transfusion and was evaluated by multispecialty team of doctors. She was advised splenectomy for transfusion-dependent pancytopaenia secondary to hypersplenism in non-cirrhotic portal hypertension. She was readmitted at 36 weeks gestation. A decision for caesarean was taken owing to failed induction of labour at 38 weeks gestation. She underwent combined caesarean with splenectomy. Mother and child had an uneventful postoperative recovery and were discharged on ninth postoperative day. Preconceptional counselling, treatment of oesophageal varices and multispecialty approach was paramount in the management. Combined caesarean with splenectomy is feasible and cost-effective treatment associated with improved quality of life. Prospective clinical trials are essential to prove safety and efficacy of treatment.

  • general surgery
  • obstetrics and gynaecology
  • portal hypertension
  • anaesthesia

https://doi.org/10.1136/bcr-2017-220561

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    Footnotes

    • Contributors MMP conceived the design. MMP was the first operating surgeon; LUC and RG were first and second assistant surgeons, respectively. Patient was evaluated, resuscitated and discussed with MMP on telephone. Patient was operated by MMP, LUC and RG. LUC performed caesarean delivery and MMP, RG and YSR performed splenectomy. RG collected the operating steps videography photographs. Demography of the patient, clinical details (data) and video editing was done by RG and YSR and further it was analysed by MMP. Manuscript was prepared by MMP, RG and YSR. Editing of image and video was performed by RG. Case report was written, critically analysed and uploaded by MMP. During first revision of case report, MMP and LUC revised and edited the case report completely. Final approval of the case report is provided by MMP, RG, LUC and YSR. Overall responsibility and corresponding author is MMP.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.