Acute surgical abdomen caused by thrombocytopenia in patients with acute leukemia and multiple myeloma.

One patient with multiple myeloma and four patients with acute leukemia presented with severe abdominal pain. Pertinent findings included numerous petechiae in the skin and buccal cavity, and diffuse abdominal guarding and tenderness, suggesting peritoneal involvement. Severe thrombocytopenia was found in all patients. Laparotomy was performed in the patient with multiple myeloma, and revealed numerous petechiae throughout the peritoneum. All five patients responded to platelet transfusions with disappearance of the abdominal signs and symptoms. Severe thrombocytopenia should be considered among the causes of acute surgical abdomen in patients with malignant hematological disorders, and platelet transfusions should be administered before any surgical intervention.