Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 218-220
DOI: 10.1055/s-0041-1729509
Case Report

Bleeding Post Constriction Ring Release Surgery Causing Lower Limb Ischemia in an Infant with Undetected Hemophilia B

S. Raja Sabapathy
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Monusha Mohan
1   Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
G. Venkateswaran
2   Department of Anaesthesiology, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Shashi Ranjani
3   Visiting Pediatric hematologist, Ganga Hospital, Coimbatore, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Bleeding in the immediate postoperative period causing compromised limb circulation is an alarming complication. It is known to occur in coagulation disorders like hemophilia. When such complications happen in a child with no previous history of bleeding problems, one has to have a low threshold for suspecting a coagulation disorder. Repeated diffuse bleeding in the whole of the surgical wound with no specific bleeders must raise the suspicion and appropriate laboratory tests must immediately be ordered. Bleeding in coagulation disorders can stop only with supplementation of the appropriate missing clotting factor. Early diagnosis is important to avoid excess morbidity. We are reporting a 6-month-old child who underwent surgery for constriction ring syndrome in the limbs with Z-plasty and developed impending limb ischemia due to bleeding in the immediate postoperative period. The article emphasizes the need to think of the possibility while encountering recurrent bleeding in the postoperative period.

Keywords

hemophilia - constriction ring syndrome - postoperative bleeding


Publication History

Article published online:
10 June 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Niblock A, Donnelly K, Sayers F, Winter P, Benson G. Avoidable compartment syndrome! High index of suspicion for a newly presenting haemophiliac: a case series. Case Rep Emerg Med 2016; 2016: 3263261
    PubMedGoogle Scholar
  • 2 Mannucci PM, Tuddenham EG. The hemophilias—from royal genes to gene therapy. N Engl J Med 2001; 344 (23) 1773-1779
    CrossrefPubMedGoogle Scholar
  • 3 Lambert C, Meité ND, Sanogo I. et al. Hemophilia carrier’s awareness, diagnosis, and management in emerging countries: a cross-sectional study in Côte d’Ivoire (Ivory Coast). Orphanet J Rare Dis 2019; 14 (01) 26
    CrossrefPubMedGoogle Scholar
  • 4 Goodeve AC. Hemophilia B: molecular pathogenesis and mutation analysis. J Thromb Haemost 2015; 13 (07) 1184-1195
    CrossrefPubMedGoogle Scholar
  • 5 Plug I, Mauser-Bunschoten EP, Bröcker-Vriends AH. et al. Bleeding in carriers of hemophilia. Blood 2006; 108 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 6 Fritz DI, Hanada T, Lu Y, Martin Johnston J, Chishti AH. MPP1/p55 gene deletion in a hemophilia A patient with ectrodactyly and severe developmental defects. Am J Hematol 2019; 94 (01) E29-E32
    CrossrefPubMedGoogle Scholar
  • 7 Hashemieh M, Mansoori B, Tavakoli R, Sheibani K. A case of concurrent proteus syndrome and hemophilia a. Iran J Pediatr 2012; 22 (02) 255-259
    PubMedGoogle Scholar
  • 8 Anderst JD, Carpenter SL, Abshire TC. Section on Hematology/Oncology and Committee on Child Abuse and Neglect of the American Academy of Pediatrics. Evaluation for bleeding disorders in suspected child abuse. Pediatrics 2013; 131 (04) e1314-e1322
    CrossrefPubMedGoogle Scholar
  • 9 Sindet-Pedersen S, Stenbjerg S. Effect of local antifibrinolytic treatment with tranexamic acid in hemophiliacs undergoing oral surgery. J Oral Maxillofac Surg 1986; 44 (09) 703-707
    CrossrefPubMedGoogle Scholar
  • 10 Lancourt JE, Gilbert MS, Posner MA. Management of bleeding and associated complications of hemophilia in the hand and forearm. J Bone Joint Surg Am 1977; 59 (04) 451-460
    CrossrefPubMedGoogle Scholar
  • 11 Jones G, Thompson K, Johnson M. Acute compartment syndrome after minor trauma in a patient with undiagnosed mild haemophilia B. Lancet 2013; 382 (9905) 1678
    CrossrefPubMedGoogle Scholar
  • 12 Orlian AI, Karmel R. Postoperative bleeding in an undiagnosed hemophilia A patient: report of case. J Am Dent Assoc 1989; 118 (05) 583-584
    CrossrefPubMedGoogle Scholar