Case Report
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World J Gastrointest Surg. Aug 27, 2013; 5(8): 252-255
Published online Aug 27, 2013. doi: 10.4240/wjgs.v5.i8.252
Successful bowel surgery at hemoglobin 2 g/dL without blood transfusion
Ramakrishnapillai Padmakumar, Madhukara Pai, Shams Farish, Jayadevan Rajeev, Thampi Sanjeev, Thekke Veetil Sreevalsan, Binu Sheetal, Yesudas Santhakumari Sooraj, Shamna Safar Rowther
Ramakrishnapillai Padmakumar, Madhukara Pai, Shams Farish, Department of General Surgery, Sunrise Hospital, Kakkanad, Kochi 682030, India
Jayadevan Rajeev, Department of Gastroenterology, Sunrise Hospital, Kakkanad, Kochi 682030, India
Thampi Sanjeev, Department of Anesthesiology, Sunrise Hospital, Kakkanad, Kochi 682030, India
Thekke Veetil Sreevalsan, Department of Critical Care Medicine, Sunrise Hospital, Kakkanad, Kochi 682030, India
Binu Sheetal, Department of General Medicine, Sunrise Hospital, Kakkanad, Kochi 682030, India
Yesudas Santhakumari Sooraj, Department of Nephrology, Sunrise Hospital, Kakkanad, Kochi 682030, India
Shamna Safar Rowther, Department of Bio-statistics, Sunrise Hospital, Kakkanad, Kochi 682030, India
Author contributions: Padmakumar R performed surgical operation, designed the report; Pai M and Farish S contributed to the surgical operation, review of literature, data collection; Rajeev J contributed to the attending doctor for the patients (colonoscopy), editing assistance; Sanjeev T, anesthesiologist for the procedure, was responsible for the literature review; Sreevalsan TV was critical care specialist; Sheetal B and Sooraj YS were attending doctors for the patient; Rowther SS organized the report, statistics, and manuscript preparation.
Correspondence to: Ramakrishnapillai Padmakumar, Consultant Surgeon, Department of General Surgery, Sunrise Hospital, Seaport-Airport Road, Kakkanad, Kochi 682030, India. drrpadmakumar@gmail.com
Telephone: +91-944-7230370 Fax: +91-984-6320370
Received: June 18, 2013
Revised: June 27, 2013
Accepted: July 17, 2013
Published online: August 27, 2013
Processing time: 102 Days and 0.4 Hours
Abstract

We were unable to find reports in the published medical literature of any cases of bowel surgery being successfully performed at such a low hemoglobin level, without blood transfusion or blood products pre or post-surgery, with the patient’s uncomplicated recovery. This study is about such a case. A patient presenting with severe gastrointestinal bleeding was diagnosed with enteric fever and multiple ileal ulcers. He had an extremely low hemoglobin level (2 g/dL) and mild renal and hepatic impairment. He was immediately admitted for right hemicolectomy under general anesthesia though he refused transfusion of blood or blood products prior to, during, or after surgery on religious grounds (Jehovah’s Witnesses). After the surgery and having survived these potentially life-threatening circumstances, he left the hospital without major complications. In such circumstances, lives may be saved by prompt clinical decision-making, collaboration and swift surgical intervention coupled with the immediate consultation and input of the patient and family.

Keywords: Gastrointestinal bleed; Low hemoglobin level; Jehovah’s witnesses; Multiple terminal ileal ulceration; Enterotomy; Right hemicolectomy.

Core tip: It is unheard of in the medical history to take up a patient with hemoglobin of 2 g/dL for anesthesia and major bowel surgery, without transfusing blood or blood products prior to, during or after surgery; and saving the life without complications. We would like to report regarding such a patient who was treated at our hospital.