POSTOPERATIVE GIANT RETROPERITONEAL HEMATOMA DUE TO THE APPEARANCE OFCOAGULATION FACTOR VIII INHIBITOR-A CASE REPORT-

Abstract

A case of giant retroperitoneal hematoma due to the appearance of coagulation factor VIII inhibitor is reported.
A 69-year-old man was admitted to the hospital because of hematemesis, and was operated on with a diagnosis of early cancer of the cardiac part of the stomach. After the operation, hemorrhage from ulcer at the anastomosed site occurred which demanded reoperation. Thereafter the patient had hematemesis again but was conservatively managed. Two months later, however, a giant hematoma was abruptly formed at the retroperitoneum and shock occurred. On a coagulation test, a prolongation in APTT alone was noted. Exploration revealed that it was bleeding tendency due to the appearance of the factor VIII inhibitor. The cause was obscure, but the APTT level was normalized for a time after starting the prednisolone regimen. An immunological analysis of the inhibitor demonstrated that it was IgG type autoantibody and IgG1 and IgG4 as IgG subclass.
Bleeding tendency due to the appearance of coagulation factor VIII inhibitor often causes severe hemorrhagic symptoms like in this case, with a high mortality rate due to hemorrhage. So the recognition and rapid treatment of the disease are of importance.