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A bleeding tendency as the first symptom of a choledochal cyst

S Ono1, K Tokiwa, S Aoi

  • 1Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.

Pediatric Surgery International
|February 9, 2000
PubMed

Insights

Gingival hemorrhages and nasal bleeding in infants can signal a choledochal cyst (CC), a congenital biliary-tract disease. Prompt vitamin K administration can resolve bleeding tendencies associated with CC.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Congenital Anomalies

Background:

  • Choledochal cysts (CC) are rare congenital dilatations of the bile ducts.
  • Early diagnosis is crucial for preventing complications like liver dysfunction and biliary atresia.
  • Bleeding tendencies in infants can stem from various causes, including vitamin K deficiency.

Observation:

  • An 8-month-old male presented with initial symptoms of gingival hemorrhages and nasal bleeding.
  • Physical examination revealed a palpable cystic mass in the right upper abdominal quadrant.
  • Laboratory results indicated moderate liver dysfunction and a bleeding tendency attributed to vitamin K deficiency.

Findings:

  • Intravenous administration of 5 mg vitamin K effectively resolved the infant's bleeding tendency.
  • Laparotomy confirmed a large choledochal cyst, 5 cm in diameter.
  • The liver exhibited moderate cholestasis, consistent with biliary obstruction.

Implications:

  • Sudden onset of bleeding in infants with congenital liver or biliary disease warrants consideration of choledochal cysts, not solely biliary atresia.
  • This case highlights the importance of considering choledochal cysts in the differential diagnosis of unexplained bleeding in infants.
  • Early recognition and management of choledochal cysts can prevent severe liver damage and improve patient outcomes.

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