Martiniuc Alexandru, Grasu Mugur, Dumitru Radu, Toma Mihai, Rusu Gina, Manga Graţiela, Scărlătescu Ecaterina, Cotruţă Bogdan, Brâză Melen, Stoia Răzvan, Herlea Vlad, Dumitraşcu Traian
Chirurgia (Bucur). 2018 Nov-Dec;113(6):857-866. doi: 10.21614/chirurgia.113.6.857.
Gastric cancer is a rare cause of upper digestive hemorrhage. Associated co-morbidities may have a detrimental effect on both early and long-term outcomes after surgery for gastric cancer. Association of gastric adenocarcinoma with hemophilia A and angiodysplasia was not previously reported, and the impact on postoperative outcome is not known. A 49-year-old male with inherited hemophilia A presented with upper digestive hemorrhage and severe anemia, and was diagnosed with gastric carcinoma. The patient underwent total gastrectomy with splenectomy and D2 lymph nodes dissection. The postoperative outcome was complicated by digestive hemorrhage due to the presence of lesions of angiodysplasia of the cecum and jejunum that were successfully treated with coils mounted by the interventional radiologic approach. During the pre and postoperative periods, the patient received human coagulation factor VIII and developed auto-antibodies against factor VIII. Thus, human coagulation factor VIII administration was stopped and replaced with factor eight inhibitor bypassing activity (FEIBA). The patient was discharged at home on postoperative day 41, without any signs of bleeding. To the best of our knowledge, this is the first reported association of gastric adenocarcinoma, hemophilia A and angiodysplasia. All these lesions may lead to digestive hemorrhage and can pose very difficult problems of decision for diagnosis and therapy. A multidisciplinary approach including hematologist, surgeon, anesthesiologist, endoscopist and the interventional radiologist is mandatory to have a proper diagnosis and management for these patients.
胃癌是上消化道出血的罕见病因。相关的合并症可能对胃癌手术后的早期和长期预后产生不利影响。胃腺癌与甲型血友病和血管发育异常的关联此前未见报道，其对术后预后的影响也未知。一名患有遗传性甲型血友病的49岁男性出现上消化道出血和严重贫血，被诊断为胃癌。该患者接受了全胃切除术、脾切除术和D2淋巴结清扫术。术后因盲肠和空肠存在血管发育异常病变而并发消化道出血，通过介入放射学方法放置线圈成功治疗。在术前和术后期间，患者接受了人凝血因子VIII治疗，并产生了针对因子VIII的自身抗体。因此，停止了人凝血因子VIII的给药，改用旁路重组活化因子VIII（FEIBA）。患者术后第41天出院，无任何出血迹象。据我们所知，这是首次报道胃腺癌、甲型血友病和血管发育异常的关联。所有这些病变都可能导致消化道出血，并且在诊断和治疗方面可能带来非常棘手的决策问题。对于这些患者，必须采用包括血液科医生、外科医生、麻醉师、内镜医生和介入放射科医生在内的多学科方法进行正确的诊断和管理。
