Disseminated intravascular coagulopathy: manifestations after a routine dental extraction.
Clinical signs and symptoms of acute disseminated intravascular coagulopathy (DIC) include bleeding from body orifices, such as the nose, mouth, or ear, bleeding from an intravenous (IV) site, areas of ecchymosis, or blood in the urine or stool. The underlying disease triggering DIC usually determines the clinical presentation. However, patients with chronic DIC (compensated DIC) may possess subclinical signs and symptoms, and the bleeding disorder may only be identified through laboratory findings. In this compensated form, the triggering factor is exposed slowly and in small amounts (seen in malignancies and vasculitis), allowing replenishing of the augmented factors by the liver, adequate reticuloendothelial clearance of fibrin degradation products, and increased production of platelets, which prevent secondary fibrinolysis and the signs of bleeding. 1,4 We report a case of an 82-year-old male who presented to the emergency room 24 hours after a routine dental extraction with bleeding from the tooth socket, severe hypotension, and presence of ecchymosis on his chest. Clinical and radiographic exam revealed multiple thoracic and abdominal aortic aneurysms, as well as infrarenal and iliac aneurysms, continuous oral hemorrhage, and a unique presentation rarely documented in the literature: a bleeding tooth socket as the initial clinical sign and presentation of DIC.
Peters
Kelly A
KA
General Practice Residency Program, Department of Restorative Dentistry and Biomaterials, The University of Texas at Houston Health Science Center, Dental Branch, 6410 Fannin, Suite 310, Houston, TX 77030, USA. kelly.a.peters@uth.tmc.edu
Triolo
Peter T
PT
Darden
Daryle L
DL
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation / Q000209:etiology* / Q000601:surgery; D005263:Femoral Artery / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000601:surgery; D008297:Male; D006472:Oral Hemorrhage / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012077:Renal Artery / Q000601:surgery; D014081:Tooth Extraction / Q000009:adverse effects*; D020390:Tooth Socket