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Case Reports
. 2021 Sep 26;9(10):1269.
doi: 10.3390/healthcare9101269.

Haemophilic Pelvic Pseudotumour: A New Surgical Option

Gianluigi Pasta  1 , Roberta Ruggieri  1 , Salvatore Annunziata  1 , Alessandro Gallese  1 , Vincenzo Pio Gagliardi  1 , Fabrizio Cuzzocrea  1 , Matteo Ghiara  1 , Mariaconcetta Russo  2 , Paola Stefania Preti  2 , Roberto Mario Santi  3 , Mario Mosconi  1 , Francesco Benazzo  1
Affiliations
Case Reports

Haemophilic Pelvic Pseudotumour: A New Surgical Option

Gianluigi Pasta et al. Healthcare (Basel). .

Abstract

Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1-2% of haemophilic patients.

Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.

Keywords: complication; haemophilia; pelvis; perioperative management; pseudotumour; surgical treatment.

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Conflict of interest statement

The authors stated that they had no interests which might be perceived ad posing a conflict or bias.

Figures

Figure 1
Figure 1
Preoperative CT scans (A–C), radiograph (D) and 3D reconstruction (E,F) of the pelvis with the right iliac pseudotumour.
Figure 2
Figure 2
Angiography of arterial embolisations, before (A) and after (B) the procedure.
Figure 3
Figure 3
First hospital stay FVIII biological activity levels preoperatively, intraoperatively and post-operatively. Pre-OP: pre-operative; POD: post-operative day.
Figure 4
Figure 4
Postoperative CT scan (A) and 3D reconstruction (B,C) of the pelvis.
Figure 5
Figure 5
One-month post-operative radiograph control.
See this image and copyright information in PMC

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