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Uncorrectable coagulopathy due to intestinal obstruction: A clinical dilemma of competing priorities in a child

V Raveenthiran1, S Balachandran

  • 1Department of Pediatric Surgery and Anesthesiology, Sri Ramasamy Memorial Medical College, Sri Ramasamy Memorial University, Kattankulathur, Chennai, Tamil Nadu, India. vrthiran@yahoo.co.in

African Journal of Paediatric Surgery : AJPS
|July 18, 2013
PubMed

Insights

Disseminated intravascular coagulation (DIC) surgery is usually contraindicated. This case report details successful emergency surgery in a pediatric patient with sepsis-induced DIC, highlighting the importance of addressing the underlying cause.

Area of Science:

  • Pediatric Surgery
  • Critical Care Medicine
  • Hematology

Background:

  • Disseminated intravascular coagulation (DIC) is a serious condition often contraindicating major surgery.
  • Managing surgical emergencies in pediatric patients with DIC presents significant clinical challenges due to limited guidance.
  • Sepsis-induced DIC following intestinal obstruction creates a critical conflict between surgical necessity and coagulation status.

Observation:

  • A 22-month-old boy with sepsis-induced DIC due to intestinal obstruction required emergency surgery.
  • Pre-operative attempts to correct coagulation parameters were unsuccessful.
  • Damage control laparotomy was performed to address the underlying intestinal obstruction.

Findings:

  • Surgical relief of intestinal obstruction rapidly normalized the patient's coagulation status.
  • Intraoperative blood loss was paradoxically less than anticipated.
  • This represents the first reported pediatric case of successful major surgery in a patient with DIC.

Implications:

  • This case suggests that prompt surgical intervention to resolve the underlying cause of DIC can be life-saving in pediatric patients.
  • It challenges the absolute contraindication of surgery in DIC when the surgery is essential for survival.
  • Further research into managing pediatric surgical emergencies in the context of DIC is warranted.

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