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Case report
A case of thrombotic microangiopathy of unknown aetiology, clinically presenting as an acute surgical abdomen
  1. Lydia Madeleine Isabel Stratford1,
  2. Isaac Nahoor2,
  3. Kataryna Dos Santos3 and
  4. Antonio Alves Dos Santos4
  1. 1 Medical School, University of Birmingham, Birmingham, UK
  2. 2 Respiratory, Russells Hall Hospital, Dudley, UK
  3. 3 General Medicine Department, Russells Hall Hospital, Dudley, West Midlands, UK
  4. 4 Upper Gastro-Intestinal Surgery, Russells Hall Hospital, Dudley, West Midlands, UK
  1. Correspondence to Dr Isaac Nahoor; isaacnahoor{at}doctors.org.uk

Abstract

A 48-year-old woman presented with severe abdominal pain, bilious vomiting and bloody diarrhoea for 1 day. On examination, she was haemodynamically unstable, febrile and clinically had an acute surgical abdomen. She had markedly raised inflammatory markers, neutrophils and deranged renal function. A CT abdominal scan revealed severe colitis and thickening throughout the length of the colon. The patient was stabilised and underwent emergency laparotomy resulting in total colectomy and end ileostomy formation. Postoperatively, she required several units of human albumin solution, red blood cell transfusions and octaplex (prothrombin complex) to prevent further bleeding. An inpatient haematology review revealed a hypocomplementaemia (C3/C4), low immunoglobulin (IgG, IgM, IgA) and peripheral blood films revealed schistocytosis indicating microangiopathic haemolytic anaemia. Bowel histology supported this, demonstrating circumferential lymphocytic phlebitis with thrombi and mucosal haemorrhage, necrosis and ulceration. The patient went on to suffer multiple ischaemic strokes before undergoing plasmapheresis, subsequent rehabilitation and making a successful recovery.

  • haematology (incl blood transfusion)
  • GI bleeding
  • haematology (drugs and medicines)
  • surgery
  • general surgery
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Footnotes

  • Contributors IN acts as the corresponding author and was involved in the initial planning of the case report, request for permissions and consent, collection and interpretation of data and follow-up relating to haematology and medicine at the patient’s initial hospital, drafting and revising versions of the work and approval of the final version as well as agreeing to be accountable for all aspects of the work. He is also responsible for responding to emails and acting upon if reports are unsubmitted. He was also involved in assisting in collection of further data to make it acceptable for resubmission. LMIS was the first author on this occasion and had a significant involvement in the initial planning of the case report, collection, analysis and interpretation of data and follow-up relating to surgery, the research of similar published articles and review, drafting and revising large sections of the work and coapproval of the final version as well as agreeing to be accountable for all aspects of the work. She has also footed the majority of the work involved in the resubmissions, contacting relevant and involved clinicians and redrafting of the work to make it acceptable for resubmission. KDS contributed to the conceptualisation, design and layout of the work, as well as providing data collection for the surgical aspect of the case and drafting sections of the work including investigations and treatment. She was also involved in approval of the final version of the work as well as agreeing to be accountable for all aspects of the work. AADS put forward the concept of this work being submitted, facilitated planning and acquiring the relevant permissions. He also assisted in data collection, interpretation of surgical findings and accessing of reports and images. He was also involved in revision of the work for intellectual content and was mainly involved in approving the final draft. He also agrees to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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