Abstract
An 18-year-old man was emergently admitted for the recurrence of left spontaneous pneumothorax. The patient had a history of left spontaneous pneumothorax treated by thoracoscopic surgery, and congenital factor VII deficiency. Laboratory data showed a prolonged prothrombin time, and factor VII activity was reduced to 46%. Chest CT scan revealed a recurrent bulla at the apex of the left lung and pneumothorax. Thoracoscopic surgery was performed, and we could identify the bulla in the apical lung after dissecting the adhesion between the left upper lobe and chest wall. The bulla was ligated with adequate hemostasis. One day after the operation, a chest radiograph revealed left hemothorax. After larger chest tube re-insertion, we noticed bloody effusion discharging from the chest tube. Although we administered hemostatics, bleeding remained uncontrolled and the patient developed anemia. Therefore, recombinant activated factor VII was administered, and the bleeding gradually stopped. The chest tube was removed 3 days after surgery, and the patient was discharged 7 days after the operation. Recombinant activated factor VII transfusion can be considered for post-operative hemorrhage in patients with congenital factor VII deficiency. In such cases, the potential risk of thromboembolic complications should be discussed before its use.
