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A case of delayed postoperative bleeding after excision of endometrial polyp using resectoscope in an infertile woman with von Willebrand disease:a case report and literature review

Chihiro Okoshi, Toshifumi Takahashi, Masahiko Fukatsu, Ryota Suganuma, Takayuki Ikezoe, Keiya Fujimori

Author information

  • Chihiro Okoshi

    Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine

  • Toshifumi Takahashi

    Fukushima Medical Center for Children and Women, Fukushima Medical University

  • Masahiko Fukatsu

    Department of Haematology Fukushima Medical University School of Medicine

  • Ryota Suganuma

    Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine

  • Takayuki Ikezoe

    Department of Haematology Fukushima Medical University School of Medicine

  • Keiya Fujimori

    Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine

Abstract

Von Willebrand disease (VWD) is a bleeding disorder caused by a congenital quantitative reduction, deficiency, or qualitative abnormality of the von Willebrand factor (VWF). Here, we report a case of delayed postoperative bleeding in an infertile woman with endometrial polyps complicated by VWD. The patient was a 39-year-old infertile woman with type 2A VWD. At 38 years of age, she was referred to our hospital for infertility and heavy menstrual bleeding. Hysteroscopy revealed a 15-mm polyp lesion in the uterus. The patient was scheduled for transcervical resection (TCR) of the endometrial polyp. Gonadotropin-releasing hormone agonists were preoperatively administered to prevent menstruation. The VWF-containing concentrate was administered for 3 days according to guidelines. The patient was discharged on postoperative day 3 after confirming the absence of uterine bleeding. Uterine bleeding began on postoperative day 6. The patient was readmitted on postoperative day 7 and treated with VWF-containing concentrate for 5 days, after which hemostasis was confirmed. TCR surgery for endometrial lesions is classified as a minor surgery, and guidelines recommend short-term VWF-containing concentrate replacement. However, it should be kept in mind that only short-term VWF-containing concentrate replacement may cause rebleeding postoperatively.

The cintent of reseach paper

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