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Hamostaseologie 2016; 36(S 02): S22-S24
DOI: 10.5482/HAMO-15-01-0003
Case report
Schattauer GmbH

Spontaneous omental bleeding in a 20-year old patient with hemophilia A

A rare cause for emergency laparotomySpontane Omentumblutung bei 20-jährigem Patienten mit Hämophilie AEin seltener Grund für eine Laparotomie
V. Aumann   *
1   Dept. of Pediatrics, University Hospital at Magdeburg
,
C. Chiapponi   *
2   Dept. of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg
,
F. Meyer
2   Dept. of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg
,
C. Wybranski
3   Dept. of Radiology and Nuclear Medicine, University Hospital at Magdeburg
,
C. J. Bruns
2   Dept. of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg
,
O. Jannasch
4   Dept. of General and Abdominal Surgery, Municipal Hospital (AMEOS-Klinikum), Haldensleben, Germany
› Author Affiliations
Further Information

Publication History

received: 30 January 2015

accepted in revised form: 01 February 2016

Publication Date:
30 December 2017 (online)

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Summary

Spontaneous intraabdominal hemorrhage is a very rare event even in patients with bleeding disorders like hemophilia. Nevertheless this rare case must be considered in patients with coagulopathies presenting with abdominal pain. Prompt radiologic imaging and surgical consultation are of highest priority. Here we report on a 20-year-old patient with moderate hemophilia A, who underwent emergency laparotomy for a spontaneous idiopathic bleeding of the omentum majus. There are few cases in the literature on this sort of event in patients with hemophilia, who mostly suffer from spontaneous joint bleedings. These patients require an intensive, interdisciplinary perioperative care, involving haematologists, surgeons, radiologists and anesthesists. Finally we discuss, whether an optimized, individually adapted treatment with coagulation factors might possibly have prevented this bleeding event in this patient.

Zusammenfassung

Spontane intraabdominelle Blutungen sind bei Patienten mit Blutgerinnungsstörungen ein sehr seltenes Ereignis. Dennoch sollte diese Möglichkeit als Ursache für akute Bauchschmerzen bei dieser Patientengruppe in die differenzialdiagnostischen Überlegungen einbezogen werden. Sofortige radiologische Bildgebung und chirurgische Konsultation sind dabei von höchster Bedeutung. Es wird über einen 20-jährigen Patienten mit mittelschwerer Hämophilie berichtet, bei dem eine Notfalllaparotomie auf Grund einer spontanen idiopathischen Blutung aus dem Omen-tum majus notwendig wurde. Nur wenige diesbezügliche Ereignisse wurden in der Literatur beschrieben insbesondere bei Blutern, bei denen sonst spontane Gelenkblutungen im Vordergrund stehen. Betroffene Patienten benötigen ein intensives interdisziplinäres Management, in welches der Hämostaseologe, Chirurg, Radiologe und Anästhesist einzubeziehen ist. Schließlich wird diskutiert, ob mittels einer optimierten, individuell angepassten Behandlung mit Gerinnungspräparaten dem Blutungsereignis hätte vorgebeugt werden können.

Keywords

Hemophilia A - intraabdominal bleeding - laparotomy

Schlüsselwörter

Hämophilie A - intraabdominelle Blutung - Laparotomie

* V. A. and C.C. were equally involved in conceptual idea, planning and creating the first draft as well as its correction and repeat proof-reading. Therefore, both should be considered as first authors.


 

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