Postoperative Bleeding

Abstract

A 50-year-old male is scheduled to undergo an elective inguinal hernia repair. He has noted pain in the hernia, which is reducible, for the past year. His past history is significant for hypercholesterolemia and mild hypertension. He has had no prior surgery. He does not smoke and only drinks occasionally. Family history is positive for coronary artery disease. He takes aspirin and a statin. He takes no herbal remedies. Otherwise, he has no significant medical history. On physical examination, he has no stigmata of portal hypertension or cirrhosis. Intraoperatively, the patient is noted to have diffuse oozing from all tissues in the operative field. Despite attempts at complete hemostasis, the patient develops a postoperative hematoma which requires evacuation on postoperative day 2. Laboratory values include a normal chemistry panel, normal hemoglobin and hematocrit, a platelet count of 250,000 cells/ml (normal 140,000–450,000 cells/ml), INR of 1.0, and a PTT of 45 seconds (normal 18–28 seconds). On further questioning, he reports a history of excessive bleeding when he had a wisdom tooth extracted 20 years ago.