Dramatic decreases of all haemorrhagic coagulation factors by acquired inhibitors after extended left lobectomy. (2019)

• Record Type: Journal Article
• Authors: Sakuraoka, Yuhki; Suzuki, Takashi; Mtsumoto, Takatsugu; Tanaka, Genki; Shimizu, Takayuki; Shiraki, Takayuki; Kyongha, Park; Mori, Shozo; Iso, Yukihiro; Kato, Masato; Aoki, Taku; Kubota, Keiichi
• Is Part Of: International journal of surgery case reports. Volume 55(2019)
• Page Start: 140
• Page End: 144
• Publication Date: 2019
• Subjects: CT computed tomography -- PT% prothrombin percentage -- PT-INR prothrombin time-international normalized ratio -- APTT activated partial thromboplastin time -- ALP alkaline phosphatase -- CEA carcinoembryonic antigen -- CA19-9 cancer antigen 19-9 -- ERCP endoscopic retrograde cholangiopancreatography -- UICC union for international cancer control -- POD post operative days -- PSL alpha-fetoprotein -- PTCD percutaneous trans-hepatic cholangiodrainage -- FFP fresh frozen plasma; Acquired inhibitors of coagulation factors -- Liver resection; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.01.020
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Required inhibitors of all coagulation factors. After liver resection. Severe bleeding. Benefits of using steroid. Abstract: Introduction: Acquired inhibition of coagulation factors is a rare disease, and the diagnosis is often difficult and delayed. We experienced a deficiency in all coagulation factors after hepatobiliary surgery. Case Presentation: Extended left liver resection was undertaken and hepaticojejunostomy was performed in a 70-year-old man. He had suffered from a high fever caused by cholangitis for 35 days. The major cause was a narrowing of the hepaticojejunostomy, and reconstruction was carried out. Twenty-four days later, there was a sudden massive bleed from his nose and the surgical site. Steroid pulse therapy was used as a treatment because cross mixing and some blood tests revealed the patient was experiencing an inhibition of all coagulation factors, and consequently the levels of coagulation factors dramatically recovered. Discussion: We considered malignancy and surgical damages to be the underlying cause. The reported treatment and examination will help clinicians explore additional reasons for massive bleeding after a severe physical injury. Conclusion: We have described the first case of acquired inhibition of all coagulation factors associated with extended left lobectomy.