Abstract
We report a case of sigmoid cancer, rectal bleeding and coexisting ITP, in which preoperative treatment with large doses of γ globulin and platelet transfusion enabled surgery to be completed safely. A man in his 90s undergoing detailed evaluation for rectal bleeding was found in colonoscopy to have a circumferential type 3 tumor of the sigmoid colon with bleeding from the site. In his 70s, the patient had been diagnosed elsewhere with idiopathic thrombocytopenic purpura (ITP) and treated for 1 month but discontinued it due to side effects. On admission, his platelet count was 16,000/μL and hemoglobin 6.3 g/dL. Before surgery, he was treated with γ globulin (20 g/day) for 5 days and underwent platelet transfusions. Platelet count improved to 255,000/μL. Sigmoidectomy and D2 lymph node dissection were done without intraoperative problems of hemostasis. Perioperatively, he had no significant bleeding. On postoperative day 2, however, platelet count decreased to 24,000/μL. The subsequent clinical course was satisfactory.
