Case 1: A 76-year-old woman with intraductal papillary
mucinous carcinoma developed
acute cholecystitis 5 days before PD. Despite immediate improvement in her
acute cholecystitis with biliary drainage and
antibiotics, her aPTT level was prolonged (55.9 s). PD was performed as scheduled. On postoperative day (POD) 2, she developed intra-abdominal hemorrhaging that required reoperation. However, intra-abdominal
bleeding and concomitant
anemia persisted after reoperation. On POD 13, she was diagnosed with AHA based on the detection of an inhibitor of
coagulation factor VIII. Despite
hemostatic and immunosuppressive treatment, including massive
blood transfusion, her general condition gradually worsened due to continuous
bleeding and
secondary infections. She ultimately died of
multiple organ failure on POD 71. Case 2: An 82-year-old man received PD for distal
cholangiocarcinoma. On POD 3, a small amount of blood via abdominal drainage was observed. On POD 4, his aPTT level was prolonged (61.5 s). On POD 8, subcutaneous hemorrhaging of the median
wound was observed, and
corticosteroids were administered under suspicion of AHA on POD 9. On POD 15, an inhibitor of FVIII was detected, and he was diagnosed with AHA. On POD 17, the aPTT level had normalized, and an inhibitor of FVIII was undetectable. On POD 41, he was discharged without any serious hemorrhagic events.
CONCLUSIONS: