Abstract
Sickle cell disease (SCD) is a common genetic disorder associated with complications such as cholelithiasis. Cholecystectomy is often performed in SCD patients, but they have a higher risk of postoperative complications. Blood transfusion, while beneficial, can also have adverse effects. The optimal approach to perioperative transfusion in SCD patients is still debated. This case report presents a rare surgical presentation of gallbladder stones in an SCD patient complicated by a hemolysis crisis and bleeding after laparoscopic cholecystectomy. A 24-year-old SCD patient with symptomatic gallbladder stones underwent laparoscopic cholecystectomy. Preoperative exchange transfusions were done to optimize hemoglobin and hemoglobin S (HbS) levels. Postoperatively, the patient experienced abdominal pain, tachycardia, and hypotension, indicating a possible hemolysis versus hemorrhagic crisis. Supportive management started but patient was still not improving and persisted to be tachycardic and hypotensive and laboratory results showed a drop in hemoglobin level (4.7 g/dL) and low platelets. A massive transfusion was activated and the patient received four units of packed red blood cells, four units of platelet and four units of fresh frozen plasma, but bleeding persisted. Laparoscopic exploration was done and oozing from liver bed was controlled and shifted again to surgical intensive care unit. Unfortunately, the next day, patient again experienced rebleeding which mandating laparoscopic converted to open laparotomy, and multiple sites of ongoing bleeding were identified and controlled with liver packing. The patient required subsequent interventions, including additional transfusions and second look and abdominal closure. After several days of intensive care, the patient's condition improved, and he was discharged with follow-up arrangements. Optimal management of surgical cases in SCD patients necessitates a multidisciplinary approach and personalized perioperative care. Preoperative transfusion should be tailored based on risk factors and the procedure. Standardized protocols and guidelines are needed to enhance perioperative management and outcomes. Prioritizing perioperative care can help mitigate complications and improve results for SCD patients undergoing surgery. Further research is required in this area.