Cecal cancer with essential thrombocythemia treated by laparoscopic ileocecal resection: a case report

General anesthesia with nerve blocks for a patient with femoral fracture and essential thrombocythemia: a case report

Essential thrombocythemia (ET) is a type of myeloproliferative neoplasm characterized by an abnormal increase in platelets. We report a female patient with a severe femoral fracture and ET who underwent the femoral intramedullary fracture fixation procedure. Her past medical history included hypertension and ET. On the second day of hospitalization, her platelet count was 922 × 109/L. In our case, general anesthesia combined with a femoral nerve block and a lateral femoral cutaneous nerve block were used when the platelet count was within normal range. After surgery, the platelet count increased to 979 × 109/L despite using anticoagulant drugs and hydroxyurea. The postoperative recovery went well after the follow-up of this patient. In this case report, we provide our experience of anesthesia management and review the progress of relevant literature to provide some reference.

Postoperative bleeding in essential thrombocytosis patients with colorectal cancer: Case report and literature review

Introduction and importance

Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by increased platelet count and a high risk of bleeding or thrombotic events due to platelet dysfunction. Patients with ET are treated according to their risk of complications with cytoreductive or anti-aggregant treatment. Neither guidelines for oncologic patients nor perioperative management of patients with ET have been determined.

Case presentation

A 41-year-old female patient with ET who had alternating constipation and diarrhea was referred after a screening colonoscopy diagnosing a locally advanced rectosigmoid junction colon adenocarcinoma with liver metastases. Systemic preoperative chemotherapy was indicated. The patient underwent laparoscopic low anterior resection plus volume-preserving right lobectomy of the liver. Postoperative bleeding of the internal iliac artery (IIA) associated with hematoma at the lower pelvic cavity was diagnosed and treated by interventional radiology; the patient was discharged without other complications 16 days after surgery.

Clinical discussion

ET has been related to the development of hematologic complications or second non-hematologic malignancies. A systematic review was conducted to seek guidance for the management of such patients in the perioperative period. Special perioperative care must be taken, and complications management should avoid further hemorrhages or cloth formation.

Conclusion

Under oncologic and hematological guidance, minimally invasive surgery and non-invasive management of complications are advised in the lack of published perioperative management guidelines of ET patients with colorectal cancer.

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Essential thrombocythemia (ET) is a rare clonal myeloproliferative disorder.

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ET can manifest as hemorrhage, thrombosis, and functional microvascular symptoms.

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Cytoreductive treatment and anti-aggregants are indicated in ET with a high risk of complications.

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Colorectal cancer, with its surgical and oncologic treatment, may increase the risk of adverse vascular events.

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Perioperative management of patients with ET has not been determined.