Abstract
We report a case of a 60-year-old man who had a long history of hemophilia B and underwent successful low anterior resection for rectal cancer. The hemophilia was diagnosed about 20 years ago. Five years earlier, he experienced bleeding at the knee and has since been receiving factor IX replacement therapy (Novact M) at intervals of once every 1-2 weeks to date. He recently noted anal bleeding ; endoscopic examination revealed a lesion approximately 3 cm across in the anterior wall of the rectum (Ra). Preoperative findings showed no distant metastases and no lymph node swelling. On the day before surgery, Novact M (4V) was administered. Surgery involved low anterior resection and ileostoma. On postoperative day 3, Novact M (2V) was administered. The postoperative course was uneventful, with no complication and no postoperative bleeding. We closed the ileostoma 6 months after the operation. Follow-up factor replacement therapy included recombinant blood coagulation factor IX (Nonakoguarufa), similar to earlier administrations. With the establishment of periodic replacement therapy, the number of long-term patients with hemophilia has been increasing in recent years, and we may expect more cases of surgery in patients with hemophilia in the future. Accordingly, gastroenterological surgeons should be aware of factor replacement therapy in the perioperative management of hemophilia.
