A Case of Thrombotic Thrombocytopenic Purpura Related to Late-onset Pancreatic Fistula after Pancreaticoduodenectomy

Takeo Nomi, Masayuki Sho, Ryo Nishinuma and Yoshiyuki Nakajima

Department of Surgery, Nara Medical University

We report a case of thrombotic thrombocytopenic purpura related to late-onset pancreatic fistula. A man in his sixties admitted for fever and abdominal pain 50 days after pancreaticoduodenectomy for intraductal papillary mucinous carcinoma was diagnosed with pancreatic fistula in computed tomography, necessitating abdominal drainage. Fever and disturbed consciousness occurred 30 days after abdominal drainage. Blood examination showed thrombocytopenia, anemia, renal dysfunction, and low ADAMTS13 activity. Based on these clinical symptoms and blood examination, we diagnosed his condition as TTP. We conducted intensive care including plasma exchange. Ninety days after TTP onset, he was cured and discharged. Although the pathogenesis of TTP after surgery is largely unknown, rapid diagnosis and proper therapy are critical to recovery.

Key words
thrombotic thrombocytopenic purpura, pancreatic fistula, pancreaticoduodenectomy

Reprint requests
Takeo Nomi Department of Surgery, Nara Medical University
840 Shijo-cho, Kashihara, 634-8522 JAPAN

Accepted
May 30, 2007

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