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Published on: February 28, 2025
Late vitamin K deficiency bleeding in an infant with choledochal cyst
Nada Krstovski1, Dragana Janic, Lidija Dokmanovic
1Department of Pediatric Hematology, University Children's Hospital, Belgrade, Serbia.
Insights
A rare cause of bleeding in infants is infantile choledochal cyst (CC). This condition can mimic biliary atresia, highlighting the importance of investigating bleeding tendencies in infants.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Infantile choledochal cyst (CC) typically presents with jaundice, vomiting, acholic stools, and hepatomegaly, often mimicking biliary atresia.
- Bleeding tendency is an uncommon but significant presentation of CC, particularly in infants under 12 months.
Observation:
- This report details a case of a two-month-old infant whose initial symptom of a choledochal cyst was late vitamin K deficiency bleeding (VKDB).
Findings:
- Early identification of conditions predisposing to VKDB and prompt management of initial bleeds are crucial for preventing severe outcomes.
- Sudden bleeding in infants with congenital liver or biliary tract disease warrants consideration of choledochal cyst, alongside biliary atresia.
Implications:
- Recognizing CC as a potential cause of late VKDB can lead to earlier diagnosis and intervention.
- Timely vitamin K administration normalizes coagulation, facilitating necessary surgical procedures for choledochal cysts.
Abstract:
Infantile choledochal cyst (CC) usually presents as jaundice, vomiting, acholic stools, and hepatomegaly, and it can resemble biliary atresia. Although bleeding tendency is a rare clinical presentation of CC, it can be the first symptom, especially in infants less than 12 months of age. We report a case of a two-month-old infant with choledochal cyst presenting as late vitamin K deficiency bleeding (VKDB). Early recognition of diseases predisposing to VKDB and immediate investigation and treatment of warning bleeds help to prevent the worst consequences. Late VKDB is often the presenting feature of a serious underlying disease that may be recognized early. The sudden onset of bleeding tendency in infants with congenital liver or biliary tract disease may suggest not only biliary atresia but also, although extremely rare, CC. Early vitamin K administration leads to rapid normalization of hemostatic parameters, which enables major liver surgery.
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