Experience in Managing Repeated Bleeding after Palatopharyngeal Plasty with Emergency Airway Establishment and Multiple Surgical Explorations for Hemostasis Across Different Hospitals ：a case report

Introduction :This patient underwent “plasma-assisted palatopharyngoplasty” at Fenggang County People’s Hospital. Due to continuous bleeding at the surgical site, the patient required three “surgical explorations for hemostasis” and two “arterial embolization procedures for bleeding control” at three separate hospitals. An emergency airway issue developed during the second hemostasis exploration, requiring a tracheotomy,during this period, the patient's blood oxygen saturation was 0% for about 3 minutes. The main diagnoses, therapeutic interventions, and outcomes : Due to the patient’s preoperative diabetes, early post-operative fever, elevated white blood cell count, and CRP levels, delayed bleeding from a surgical site infection was initially suspected, leading to a failure to consider coagulation factor-related problems.The patient was diagnosed with occult hemophilia at the third hospital and was eventually discharged after active symptomatic treatment. Conclusion: For emergency airway management due to secondary bleeding in the pharyngopalatal surgical area, it is crucial to following established difficult airway management protocols during anesthesia induction. If multiple surgical explorations, hemostasis interventions, and embolization fail to control bleeding, coagulation factor abnormalities should be strongly considered.The successful management of occult hemophilia relied on an accurate diagnosis of the underlying condition and the prompt administration of appropriate replacement therapy.