A Case of Traumatic Sigmoid Mesenteric Injury Associated with Hemophilia for which Appropriate Coagulation Factor Replacement was Effective

Abstract

A 51-year-old man presented with congenital hemophilia A and was self-injecting factor VIII twice a week. He was urgently transported to our hospital due to a traffic accident. Contrast-enhanced CT revealed extravasation of the contrast agent around the sigmoid mesentery and a large amount of ascites ; thus, intraperitoneal bleeding due to traumatic sigmoid mesenteric injury was suspected and emergency laparotomy was performed. Hemostasis was performed on the bleeding sigmoid mesenteric injury site and three non-full-layer injuries on the sigmoid colon were repaired. An artificial anus was then constructed in the descending colon. During the operation, there was no factor VIII in the hospital ; therefore, 16 units of fresh frozen plasma and 2 g of fibrinogen were administered to replace the coagulation factor. After the surgery, factor VIII was administered according to the guidelines. The ventilator was withdrawn on the 10th postoperative day, and the patient was transferred to a different hospital on the 30th postoperative day. We report the case of a patient with traumatic sigmoid mesenteric injury complicated with hemophilia A, who survived emergency abdominal surgery with the administration of fresh frozen plasma and fibrinogen without factor VIII preparation in the hospital.