A Case Report of Early Gastric Cancer in Association with Congenital Factor X Deficiency

Takao Takahashi, Yoshitaka Yamamura, Hiroshi Matsuo, Yasuhiro Kodera, Tsuyoshi Kito, Hideki Toyoda*

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
*Department of Gastroenterological Medicine, Aichi Cancer Center Hospital

A 75-year-old woman complained of appetite loss and was given a diagnosis of early gastric carcinoma of the antrum adjacent to the lesser curvature. She was found to have a prolonged prothrombin time by the preoperative hematologic evaluation. A closer examination that followed led to a diagnosis of congenital factor X deficiency with a decrease in the serum level of factor X to 34%. This necessitated the perioperative use of a combined coagulation factor complex (PPSB^®-HT) to ensure hemostasis, and chronological changes in the serum factor X levels following parenteral administration of a test-dose of PPSB^®-HT were monitored preoperatively to determine the optimal dose. Distal gastrectomy with adequate lymphadenectomy was performed, and PPSB^®-HT was administered for 4 days starting on the day of the operation. As a result, hemostasis was readily observed during the operation and no untoward postoperative hemorrhage occurred. Referring to the domestic literature revealed only 2 cases of surgery performed in a patient with this rare congenital deficiency. In this study, we have shown that adequate administration of PPSB^®-HT maintains the perioperative activity of factor X, and enables a safe abdominal operation.

Key words
congenital factor X deficiency, bleeding tendency, gastrectomy

Reprint requests
Takao Takahashi Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusaku, Nagoya, 464 JAPAN

Accepted
July 2, 1997

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