Postoperative bleeding complicated by hemophilia A following anal fistula surgery: A case report

Rationale: Postoperative hemorrhage is a known complication of anal fistula surgery, but underlying coagulation deficiencies like hemophilia can be a rare and potentially severe cause. In this report, we present a case of recurrent postoperative bleeding after anal fistula surgery caused by hemophilia A. Patient concerns: This article reports a 48-year-old Chinese male patient who developed repeated wound bleeding and subcutaneous hematoma in the perianal and scrotal regions after high anal fistula incision and seton placement. Diagnoses: Coagulation studies revealed a significantly prolonged activated partial thromboplastin time of 58.10 seconds. The activated partial thromboplastin time normalized (31.00 seconds) after correction via mixing test. Further coagulation factor activity assays demonstrated a markedly reduced factor VIII level of 2.40 %, leading to a definitive diagnosis of Hemophilia A. Interventions: Initial hemostatic measures included local compression, suturing, and intravenous hemostatic agents, which proved ineffective. The patient then received fresh frozen plasma transfusions (total 1600 mL); however, no significant improvement was observed. He was subsequently transferred to a specialized center for Factor VIII replacement therapy. Outcomes: The patient’s wound bleeding gradually ceased. At the 17-day follow-up, the wound was nearly healed with no further bleeding episodes observed. Lessons: Hemophilia is a risk factor for postoperative bleeding after anal fistula surgery. In patients with moderate or mild hemophilia, symptoms may be subtle, typically only manifesting after trauma or surgery. Therefore, it is crucial to inquire about the patient’s bleeding history and monitor blood test results preoperatively.