A Case Report of Acquired Hemophilia after Robot-Assisted Laparoscopic Gastrectomy for Gastric Cancer

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  • Nishi Satoshi
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Miki Yuichiro
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Yoshii Mami
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Miyamoto Hironari
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Nanbara Mikio
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Tamura Taturo
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Toyokawa Takahiro
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Tanaka Hiroaki
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Lee Shigeru
    Department of Gastroenterological Surgery, Osaka Metropolitan University
  • Ohira Masaichi
    Department of Surgery, Baba Memorial Hospital

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  • ロボット支援下胃切除術後に出血を契機に診断された後天性血友病の1例

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Abstract

<p>We report a rare case of acquired hemophilia A in a patient with gastric cancer that was diagnosed after postoperative bleeding. A 79-year-old man was admitted to our hospital for surgical treatment for gastric cancer, and underwent robot-assisted distal gastrectomy. On postoperative day (POD) 2, he presented with severe anemia. CT showed high density areas in the stomach, and hematoma was suspected. Upper GI endoscopy also showed digestive bleeding. A postoperative coagulation study revealed prolongation of the activated partial prothrombin time (APTT) to 63.9 s. Since further examination revealed a very low factor-VIII activity (6%) and a high factor-VIII inhibitor level (27 BU/ml), the patient was diagnosed with acquired hemophilia A. Initial treatment was started with recombinant activated factor VII/X and prednisolone. The prolonged APTT gradually normalized over about two weeks and the patient was discharged on POD 23. This case suggests that acquired hemophilia A could be a differential diagnosis in a case with severe postoperative bleeding after surgery for several types of cancer.</p>

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