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Kondo H, Hirano Y, Ishii T, Hara K, Ishikawa S, Okada T, Obara N, Wang L, Yamaguchi S. A successful case of laparoscopic colorectal cancer resection in an elderly patient with factor XI deficiency. Surg Case Rep 2019; 5:84. [PMID: 31119406 PMCID: PMC6531558 DOI: 10.1186/s40792-019-0643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Congenital XI factor deficiency is a rare disease caused by autosomal recessive inheritance. Clinically, there are few spontaneous hemorrhages, which can cause abnormal bleeding after trauma, surgery, and tooth extraction. We experienced a colon cancer patient with congenital XI factor deficiency who was successfully treated by laparoscopic approach with the administration of the preoperative fresh frozen plasma (FFP). Case presentation The patient was an 82-year-old woman who complained of right lower abdominal pain for a period of 2 months with no previous history of abnormal hemostasis. She received colonoscopy and was diagnosed with ascending colon cancer. Preoperative blood tests resulted in prolongation of activated partial thromboplastin time (APTT). After further investigation, factor XI (FXI) activity was found to be abnormal at 3.0% and congenital FXI deficiency was diagnosed. By replenishing FXI by FFP, APTT was improved to 37 s so perioperative abnormal bleeding could be avoided and an operation for ascending colon cancer performed. The patient received laparoscopic ileocolic resection and was discharged on a postoperative day 7 uneventfully. Conclusion It is important to detect coagulation disorders such as FXI deficiency during routine preoperative checkups, and it is also important to consider unrecognized coagulation disorders if we encounter unexplained abnormal bleeding after surgery or trauma. In patients who have already been diagnosed with FXI deficiency, appropriate treatment including administration of FFP should be considered before surgery, and laparoscopic approach has a possibility to bring safety outcomes as an effect of the reduction of the intraoperative bleeding.
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Affiliation(s)
- Hiroka Kondo
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Toshimasa Ishii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Kiyoka Hara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shintaro Ishikawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Takuhisa Okada
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Nao Obara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Liming Wang
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
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Sano K, Homma Y, Baba T, Ando J, Matsumoto M, Kobayashi H, Yuasa T, Kaneko K. Total hip arthroplasty via the direct anterior approach with Kerboull-type acetabular reinforcement device for an elderly female with factor XI deficiency. SICOT J 2017; 3:11. [PMID: 28186870 PMCID: PMC5302879 DOI: 10.1051/sicotj/2016046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
We present a case of successful and uncomplicated total hip arthroplasty with an acetabular reinforcement device in an elderly patient with hip osteoarthritis already diagnosed with factor XI deficiency, which is a very rare bleeding disorder and at high risk of post-operative haemorrhage, and it poses a substantial challenge to surgeons as a consequence of the specific risks of infection and fixation failure. Moreover, bone fragility in elderly patient increases potential risk of adverse event. Fresh frozen plasma was used to supplement factor XI activity. Importantly, transfusion-transmitted disease such as having factor XI inhibitor was promptly surveyed prior to the supplement since the patient had previous history of the administration of fresh frozen plasma. Under prompt and effective peri-operative haemostasis, rigid implant fixation and rigorous attention to the prevention of infection seem to achieve the best possible outcomes for elderly patients with a bleeding disorder undergoing total hip arthroplasty.
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Affiliation(s)
- Kei Sano
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Jun Ando
- Division of Hematology, Department of Internal Medicine, Juntendo University, Tokyo 113-0033, Japan
| | - Mikio Matsumoto
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Takahito Yuasa
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, Tokyo 113-0033, Japan
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