Emergency Splenectomy For A Traumatic Splenic Rupture In An Elderly Patient With Undiagnosed Acquired Hemophilia: A Case Report
Among the rare coagulopathies that can be revealed by trauma or surgery, acquired hemophilia holds
a special place. It is an autoimmune pathology linked to the presence of inhibitors directed against
coagulation factor VIII, resulting in spontaneous or trauma-induced bleeding. We report the case of
a 70-year-old patient admitted to the Yaoundé emergency center, presenting with a traumatic splenic
rupture, in whom the persistence of an unusual hemostatic disorder led to the diagnosis of acquired
hemophilia.
Emergent general surgery leads to significant morbidity and mortality in older patients. While clinical
outcomes after elective operations are similar in younger and older patients, the latter have higher
rates of complications and mortality after emergency surgery. Abdominal surgical procedures such as
colectomy, small-bowel resection, cholecystectomy, appendectomy, and others constitute ~80% of all
emergent surgeries performed in older patients. The risk of surgical bleeding can be minimized by
judicious administration of fresh frozen plasma at induction, during, and after surgery under the close
supervision of hemophilia specialists.
The successful outcome demonstrates that major emergent abdominal surgery, even highly hemorrhagic
procedures like splenectomy, can be safely performed in patients with hemophilia (or severe coagulopathy)
provided a continuous and closely monitored factor replacement regimen is implemented.
