Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review

Abstract

Background Hemophilia is a recessive hemorrhagic disease relevant to X chromosome. In mild hemophilia cases, spontaneous bleeding is rare and the blood clotting function is normal, but severe bleeding may occur after trauma or surgery. Therefore, missed diagnosis of hemophilia before operation may contribute to bleeding after hemorrhoid operation. Case presentation A 21-year-old male was hospitalized in the anorectal department because of repeated bleeding after hemorrhoid surgery. Despite several suture hemostasis procedures, the patient still suffered from recurrent bleeding. He had no family history of hemophilia or bleeding tendency, and had not been diagnosed with hemophilia before this admission. The diagnosis of mild hemophilia B was made after further examination of coagulation indexes. By using frozen plasma and coagulation factor complex to supplement coagulation factors, the patient’s bleeding was stopped and he was discharged after 23 days in hospital. During the follow-up, lower-than-normal coagulation factors were still found in him, but no bleeding occurred again. Conclusions The undiagnosed patient with mild hemophilia B has an increased risk of bleeding after hemorrhoid surgery because of the consumption of coagulation factors. This case report aims to address the importance of hemophilia screening before operation and reduce the risk of postoperative bleeding. For patients with recurrent bleeding after hemorrhoid surgery, hemophilia should be further excluded. Wound bleeding may recur in hemophilia patients after suture hemostasis. Therefore, prompt supplementation of coagulation factors is needed to help stop bleeding once the diagnosis of hemophilia is made.

Indirect Coagulation of Residual Lesions of Circumferential Piles after Excisional Hemorrhoidectomy; a Prospective Controlled Pilot Study

“…1 It is prevalent among the general population, reaching up to 38.9% in some studies. 2 In its simplest form, hemorrhoids can be defined as a symptomatic dilatation of the hemorrhoidal venous plexus leading to distal displacement of the normal anal cushions 3 manifested as perianal swelling, itching, fresh bleeding per rectum and fecal soiling. 4 Hemorrhoids used to be described as anal varicose veins.…”