2020 Volume 53 Issue 8 Pages 439-446
A 69-year-old male had a history of a thoracic dissecting aortic aneurysm, which was conservatively monitored. He was started on dialysis due to nephrosclerosis in year X-2. However, it was difficult to create an arteriovenous fistula because of his bleeding tendency. Resurgery and hematoma removal were subsequently required. Conspicuous hemorrhagic symptoms were seen, even after the introduction of hemodialysis, and anticoagulants were not used during the hemodialysis due to the difficulty of achieving hemostasis after the shunt puncture. The patient visited a hospital in week X-5 because of a buccal mucosal hematoma, which had formed after an accidental bite. Despite outpatient treatment, the hematoma continued to grow. Therefore, he was hospitalized to undergo surgery under general anesthesia. The buccal mucosa was sutured, but the hematoma continued to grow. On the ninth day of his hospitalization, a giant subcutaneous hematoma formed on his back. Blood tests suggested that his chronic disseminated intravascular coagulation had been exacerbated by the dissecting aortic aneurysm and secondary factor XIII deficiency-related bleeding. However, since radical surgery was considered difficult, tranexamic acid and recombinant human thrombomodulin were administered in addition to a blood transfusion. Afterwards, all of the patient’s bleeding symptoms, including the buccal mucosal hematoma, were ameliorated, and hemostasis became easier to achieve during dialysis. Therefore, dialysis could be continued without performing radical surgery for the aortic aneurysm.
