Pol Manjunath Maruti, Chawla Latika Uniyal, Rathore Yashwant Singh, Goel Ritesh
Department of Surgical Disciplines (General Surgery), All India Institute of Medical Sciences, New Delhi, Delhi, India.
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India.
BMJ Case Rep. 2017 Sep 15;2017:bcr-2017-220561. doi: 10.1136/bcr-2017-220561.
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.
一名妊娠28周的24岁女性从外周医院转诊而来，诊断为妊娠合并门静脉高压。她过去因全血细胞减少接受过多次输血，并因食管静脉曲张接受过内镜硬化治疗。最初，她在妊娠28周时入住我院接受输血，并由多专科医生团队进行评估。由于非肝硬化门静脉高压继发脾功能亢进导致依赖输血的全血细胞减少，建议她行脾切除术。她在妊娠36周时再次入院。由于妊娠38周引产失败，决定行剖宫产。她接受了剖宫产联合脾切除术。母婴术后恢复顺利，术后第九天出院。孕前咨询、食管静脉曲张的治疗以及多专科方法在管理中至关重要。剖宫产联合脾切除术是一种可行且具有成本效益的治疗方法，可改善生活质量。前瞻性临床试验对于证明治疗的安全性和有效性至关重要。
