A 6-year-old girl presented with presumed relapse of childhood immune thrombocytopenia. Investigations revealed deranged coagulation parameters, abnormal small bowel thickening, and splenomegaly. A clinically significant bleeding diathesis emerged which was refractory to most hemostatic interventions. Laparatomy revealed a composite diagnosis of splenic hemangiomatosis and small bowel lymphangiomatosis. Splenectomy resulted in complete resolution of the coagulopathy. The diagnosis and management of these conditions is inherently complex and without clear guidance. We discuss our perioperative management of the bleeding diathesis. There is a need for long-term follow-up of the underlying pathologies particularly as potentially useful therapeutic agents have emerged.
*Department of Haematology, Belfast City Hospital
†Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
‡Our Lady’s Children’s Hospital, Crumlin, Dublin, Republic of Ireland
The authors declare no conflict of interest.
Reprints: Patrick T. Elder, MB ChB, MRCP, FRCPath, Department of Haematology, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK (e-mail: firstname.lastname@example.org).
Received March 7, 2013
Accepted August 20, 2013