Bleeding tendency in an adolescent with chronic small bowel obstruction

Area of Science:

• Gastroenterology
• Pediatric Medicine
• Nutritional Science

Background:

• Chronic duodenal obstruction can lead to gastrointestinal complications.
• Fat malabsorption is a known complication of prolonged small bowel obstruction.
• Nutritional deficiencies can arise secondary to malabsorption syndromes.

Observation:

• A 14-year-old male presented with unexplained bleeding and signs of fat malabsorption.
• Laboratory findings included fat globules in stool, prolonged prothrombin time, and low vitamin A and E levels.
• Clinical presentation suggested a link between duodenal obstruction and vitamin deficiency.

Findings:

• Parenteral vitamin K and oral vitamin A and E supplementation corrected the biochemical abnormalities.
• Persistent neurological deficit (absent knee jerk) noted despite nutritional correction.
• Bacterial overgrowth and bile acid deconjugation were proposed as mechanisms for fat malabsorption.

Implications:

• Fat-soluble vitamin deficiency screening is recommended for patients with chronic small bowel obstruction.
• Early diagnosis and management can prevent severe complications.
• This case underscores the importance of investigating nutritional status in obstructive gastrointestinal conditions.