title: A bleeding tendency as the first symptom of a choledochal cyst.
abstract: We report an 8-month-old male presenting with gingival hemorrhages and nasal bleeding as the first symptom of a choledochal cyst (CC). On physical examination, there was a large cystic mass in the right upper abdominal quadrant. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin K deficiency. After administration of 5 mg vitamin K the bleeding tendency disappeared. At laparotomy, a large CC 5 cm in diameter was found and the liver showed moderate cholestasis. The sudden onset of a bleeding tendency in infants with congenital liver or biliary-tract disease may suggest not only biliary atresia, but also CC.
authors.affiliation: Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ono
authors.forename: K
authors.initials: K
authors.lastname: Tokiwa
authors.forename: S
authors.initials: S
authors.lastname: Aoi
authors.forename: N
authors.initials: N
authors.lastname: Iwai
authors.forename: H
authors.initials: H
authors.lastname: Nakanoin
mesh_terms: D015529:Choledochal Cyst / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004844:Epistaxis / Q000209:etiology; D005884:Gingival Hemorrhage / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male