Acute recurrent appendicitis in a hemophiliac Nepalese girl: beyond just… avoidance of formidable cuts! – A case report

Introduction: Bleeding, an unavoidable yet mostly controllable event in surgery can present with intimidating challenges. The risks are calculably more and foreseeably torrential when confounded with a known bleeding diathesis like Hemophilia. Already a rare finding due to an X-linked recessive inheritance in females, the condition is also exceedingly uncommon in children. Presentation of case: We hereby present an 8-year-old girl with hemophilia A presenting with acute recurrent appendicitis. She underwent a standard three-port laparoscopic appendectomy as an emergency procedure using 3 mm instruments under suitable anesthesia and perioperative factor VIII replacement. She had an entirely uneventful perioperative period with an optimal outcome. Discussion: All hemophiliacs, regardless of severity, are at risk of bleeding and present with unique surgical challenges, especially in rare cases of female hemophiliacs presenting with appendicitis, as demonstrated by this case. Moreover, management requires robust laboratory and blood bank support, along with close coordination between the surgeon and anesthesiologist at all times. Laparoscopic techniques can provide a safe and effective outcome even in such cases. Conclusion: This case demonstrates that with a precisely tailored surgical and anesthetic management strategy, desired result can be achieved even in such high-risk cases.