Anesthetic Challenges in Pregnancy with Wilson’s Disease Associated with Massive Splenomegaly Complicated with Intramyometrial Carboprost: A Case Report

Jyoti P Deshpande; Merlin Elizabeth Jacob

doi:10.18502/aacc.v9i2.12529

Jyoti P Deshpande Department of Anaesthesiology and Critical Care, Smt Kashibai Navale Medical College and General Hospital Narhe-Pune, MUHS University, Nashik, India.
Merlin Elizabeth Jacob Department of Anaesthesiology and Critical Care, Smt Kashibai Navale Medical College and General Hospital Narhe-Pune, MUHS University, Nashik, India.

DOI: https://doi.org/10.18502/aacc.v9i2.12529

Keywords: Carboprost; Caesarian section; Massive splenomegaly; Wilson’s disease

Abstract

Wilson’s disease is a rare autosomal recessive condition, that affects the liver and brain mainly. Pregnancy in these patients is of high risk due to involvement of liver and high incidence of abortion, preeclampsia, HELLP syndrome. We report a case of a 24year old G2A1 (35+2 weeks) diagnosed with wilson’s disease 6 years ago, currently on tab zinc. She presented with thrombocytopenia, anemia, extrahepatic portal vein occlusion with splenomegaly and mild ascites. She was taken up for elective section at 35+2 weeks, under general anesthesia. With intramyometrial injection of carboprost, there was sudden desaturation and bronchospasm. However, we managed the case successfully with safe outcome of both the mother and child. There are only very few case reports of Wilson’s disease in pregnancy undergoing C-section under general anesthesia in the presence of hepatic dysfunction.