A CASE OF ACQUIRED HEMOPHILIA A WITH REPEATED BLEEDING AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

A 62-year-old man had been diagnosed two years prior with acquired hemophilia A. Although combination therapy of steroids and rituximab could have induced disease remission, the treatment needed to be reinstated after a recurrence following steroid discontinuation. Colonoscopic examination for bloody stools revealed a laterally spreading tumor in the rectum with a diameter of approximately 60 mm. In spite of the patient’s tendency to bleed, tumor resection with curative intent was indicated, and endoscopic submucosal dissection was performed with coagulation factor replacement. After the procedure, the patient exhibited chronic bloody stools and anemia, with frequent bleeding from the resection site. With repeated blood coagulation factor supplementation and blood transfusions, along with nine endoscopic hemostasis procedures, the patient ultimately achieved complete hemostasis in a period of approximately three weeks.