SPLENECTOMY IN AN ABNORMAL COAGULATION PROFILE PATIENT WITH EXTRA-HEPATIC PORTAL VENOUS OBSTRUCTION

The clinico-surgical implication and successful management of a case of an abnormal coagulation profile patient withportal hypertension and splenomegaly due to extra-hepatic portal venous obstruction is presented. A 14-year old girl had gastro-esophageal variceal bleeding and splenomegaly. During preoperative workup prolonged prothrombin time and severe thrombocytopenia were detected. Splenectomy with devascularisation was successfully performed with transfusion of fresh frozen plasma and platelet rich plasma in the perioperative period. At surgery there was no excessive bleeding. The perioperative course was uneventful and the patient is doing well on follow up. Surgical portal decompressive procedures can be safely undertaken in an abnormal coagulation profile patientswith portal hypertension if meticulous surgical hemostasis is achieved at operation and the deficient blood products are adequately replaced in the perioperative period.