Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency

Abstract

Rationale:The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time.Patient concerns:An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting.Diagnoses:He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency.Interventions:Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy.Outcomes:The patient had an uneventful recovery.Lessons:It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

Hematoma De Músculo Psoas Em Paciente Portador De Hemofilia a Vítima De Trauma Abdominal Fechado: Relato De Caso

“…Por sua vez, o tratamento cirúrgico é indicado nos casos de trauma abdominal fechado em pacientes com hemofilia que apresentam instabilidade hemodinâmica persistente, sinais de peritonite, suspeita de lesão de órgãos ocas ou falha do tratamento conservador (Castro Júnior et al, 2019;He;Feng, 2017). Consiste na exploração da cavidade abdominal por meio de laparotomia ou laparoscopia, na identificação e no controle das fontes de sangramento e na correção das lesões de órgãos ou vasos Mistry et al, 2017).…”