Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2836-2839
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2836
Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: A case report
Hai-Hong Zhang, Guo-Li Gu, Xiang-Yang Zhang, Qin Fan, Xin-Yan Wang, Xue-Ming Wei
Hai-Hong Zhang, Guo-Li Gu, Xue-Ming Wei, Department of General Surgery, Air Force General Hospital of PLA, Beijing 100142, China
Xiang-Yang Zhang, Qin Fan, Xin-Yan Wang, Department of Intelligence, Air Force General Hospital of PLA, Beijing 100142, China
Author contributions: Zhang HH, Gu GL and Wei XM designed the research; Zhang HH and Fan Q performed the research; Zhang XY and Wang XY provided the analytic tools; Fan Q analyzed the data; and Zhang HH wrote the manuscript.
Supported by National Key Technology Research and Development Program of the Ministry of Science and Technology, No. 2012BA141 B01; and the Air Force General Hospital Annovation Fund, No. KZ2013035.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xue-Ming Wei, Professor, Department of General Surgery, Air Force General Hospital of PLA, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. hhzhangbj301@126.com
Telephone: +86-10-66928302 Fax: +86-10-66928302
Received: August 24, 2014
Peer-review started: August 24, 2014
First decision: September 17, 2014
Revised: December 8, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: March 7, 2015
Processing time: 197 Days and 5.5 Hours
Abstract

A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases. Blood routine test showed a leukocyte count of 22.74 × 109/L, with 91.4% neutrophils, and a platelet count of 4 × 109/L before admission. The case question was whether the team should proceed with surgery. Obviously, a differential diagnosis is essential before making such a decision. Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 109/L and the result of abdominal computed tomography scan. However, it was not clear whether the severe thrombocytopenia was primary or secondary. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases. Neither of the tests indicated obvious pathological hematological changes. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.

Keywords: Thrombocytopenia; Appendicitis; Infection; Fever; Appendectomy

Core tip: Should acute appendicitis with severe thrombocytopenia be operated? There are no reports about this clinical scenario. Acute appendicitis was diagnosed based on clinical findings, which included migrating right lower abdominal pain, a leukocyte count of 22.74 × 109/L and the result of abdominal computed tomography scan. However, we were not sure whether the severe thrombocytopenia was primary or secondary in nature. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude the primary thrombocytopenia. Neither examination indicated any pathological changes in the hematological system. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, there were no contradictions for acute appendicitis patients with thrombocytopenia.