Abstract
A 73-year-old man was referred to the hospital with a diagnosis of acute cholecystitis with thrombocytopenia. He was diagnosed as having idiopathic thrombocytopenic purpura (ITP) by preoperative blood examination. Although steroid therapy, high-dose transvenous γ-globlin therapy and eradication of Helicobacter pylori were performed, his platelet count did not increase as expected. Moreover, frequent chest oppression appeared after admission, and coronary angiography revealed severe triple vessel disease. Combined operation of off-pump coronary artery bypass graft (OPCAB) with cholecystectomy and splenectomy was performed safely with platelet transfusion, and he was transferred to another hospital for rehabilitation on the 29th postoperative day. Intraoperative platelet transfusion and selection of OPCAB were useful to prevent perioperative complication of bleeding. This is the first report of combined surgery in a patient with ischemic heart disease complicating by cholecystitis and ITP.
