title: [Peritoneal bleeding due to acquired hemophilia during an abdominal sepsis clinical picture].
abstract: Bleeding diatheses are frequent alterations during sepsis and surgical-anesthetic aggression. Generally, the bleeding is related with platelet dysfunction, inadequate surgical hemostasis, vitamin K deficit, etc. We present the case of a patient with no background of coagulopathy who, after two surgical interventions, developed abdominal sepsis and peritoneal hematoma after puncture for drainage of abdominal collection, due to an autoimmune origin factor VIII acquired deficit. The hematoma caused a picture of hypovolemic shock that required transfusion of several units of red blood cells, expansion and drug support. Finally, the bleeding was controlled by treatment with immunosuppressants, recombinant activated factor VII (RFVIIa) and polyvalent gammaglobulin. The peritoneal hematoma was drained surgically and the patient evolved towards improvement until being discharged from the intensive therapy unit.
authors.affiliation: Unidad de Terapia Intensiva, Hospital de Agudos «Donación Francisco Santojanni», Buenos Aires, Argentina. jorge.vazquez@hospitalitaliano.org.ar
authors.forename: J A
authors.initials: JA
authors.lastname: Vázquez
authors.forename: D N
authors.initials: DN
authors.lastname: Chiacchiara
authors.forename: M C
authors.initials: MC
authors.lastname: Adducci
authors.forename: A E
authors.initials: AE
authors.lastname: Pilipec
authors.forename: G
authors.initials: G
authors.lastname: Leone
authors.forename: E
authors.initials: E
authors.lastname: González
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000601:surgery; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D016913:Blood Component Transfusion; D003131:Combined Modality Therapy; D004322:Drainage; D015942:Factor VIIa / Q000627:therapeutic use; D006465:Hemoperitoneum / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010538:Peritonitis / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D012769:Shock / Q000209:etiology / Q000628:therapy; D013396:Suction / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000150:complications* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa