Acute abdomen in a patient with haemophilia A: A case study
Keywords:Acute abdomen, haemophilia A, factor VIII, TAP block, coagulopathy
Background: Haemophilia A is a hereditary haemorrhagic disorder that can cause bleeding in the intestinal loops and, on rare occasions, simulate an acute surgical abdomen. Careful assessment of coagulation must be performed in these patients, followed by an attempt to correct the dysfunctions. Often, the administration of the deficient factor is sufficient to resolve the problem, avoiding unnecessary surgeries.
Case report: We present a male patient, 15-years-old, of indigenous descent, who was a diagnosed with haemophilia A. The young man was admitted with abdominal pain in the right iliac fossa; ultrasonography suggested acute appendicitis. He underwent an exploratory laparotomy that revealed a normal appendix and the presence of a caecal wall haematoma, without other abnormalities.
Conclusion: This case describes an unusual instance of decompensation of a patient with haemophilia A that simulated an acute surgical abdomen. The case suggests the need for further evaluation of carriers of coagulopathies, whether acquired or congenital, when they suffer abdominal pain. Otherwise, clinically treatable dysfunctions are prone to surgical treatment, with a potential for increased morbidity and mortality.Â
Flores RPG, Bagatini A, Santos ATL, Gomes CR, Fernandes MS, Molon RP. Hemophilia and anesthesia. Rev Bras Anestesiol 2004, 54:6:865-871.
Redwine J, Bold RJ: Perioperative care of the patient with hemophilia undergoing urgent appendectomy. Arch Surg 2007, 142(9):894-897.
Rabie ME, Al-Tayeb AR, Zafer MH, Sheikha AK..: Hemorrhagic episodes in hemophiliacs simulating abdominal surgical emergencies. Saudi Med J 2001, 25(1):95-8.
Roy V, Tillyer ML, Colvin BT: Acute abdominal pain due to an acquired disorder of coagulation. BMJ 1998, 296:1460.
Carkman S, Ozben V, Saribeyoglu K , Somuncu E, ErgÃ¼ney S, Korman U, Pekmezci S: Spontaneous intramural hematoma of the small intestine. Turkish J of Trauma & Emerg surg ;2010, 16(2):165-169.
Ramadan KM, Lowry JP, Wilkinson A, McNulty O, McMullin MF, Jones FG Acute intestinal obstruction due to intramural haemorrhage in small intestine in a patient with severe haemophilia A and inhibitor. Eur J Haematol ;2005, 75(2):164-166.
Girolami A, Luzzatto G, Varvarikis C, Pellati D, Sartori R, Girolami B.: Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking. Haemophilia 2005, 11(3):193-202.
Gyanesh P, Dhiraaj S: Anesthetic management of a patient with hemophilia A with spontaneous acute subdural hematoma. J Anaesthesiol Clin Pharmacol 2013, 29(1):117-120.
Harry e, macCoy III, Craig S, Kitchens MD: Small bowel hematoma in a hemophiliac as a cause of pseudoappendicitis: Diagnosis by ct imaging. Americ J of Hematol 1991, 38(2):138-139.
Pieper GR, Perry S, Burroughs : Surgical intervention in hemophilia: review of the literature and report of two cases. JAMA 1959, 170(1):33-37.
Gamba G, MaffÃ© GC, Mosconi E ,Tibaldi A, Di Domenico G, Frego R.: Ultrasonographic images of spontaneus intramural hematomas of the intestinal wall in two patients with congenital bleeding tendency. Haematologica 1995, 80:388-389.
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