An unusual complication of ice skating and the emergence of a previously undiagnosed bleeding disorder.
We report the case of an 8-year-old boy with no prior abnormal bleeding history who presented with severe central abdominal pain following a freak accident at a local ice rink. Clinical examination confirmed a tender periumbilical mass. An ultrasound scan confirmed a large haemorrhagic fluid collection adjacent to the second part of his duodenum that was causing a subacute small-bowel obstruction. He was found to have a persistently prolonged prothrombin time between 17.3 and 18.1 s but normal liver function tests. There was no suggestion of dietary vitamin K deficiency. Further investigations confirmed factor VII deficiency with levels between 30.4 and 33.6 IU dL-1. His prothrombin time did not normalize with intravenous vitamin K. He was subsequently treated with three 30 microg kg-1 body weight doses of novoseven at 4-h interval and made an excellent recovery. The haematoma virtually resolved completely confirmed by a follow-up ultrasound scan 3 months after the initial event.
Mainwaring
C J
CJ
Haematology, North Hampshire Hospital, Basingstoke, UK. cjmainwaring@tiscali.co.uk
Pleydell-Pearce
J
J
Chana
J
J
Evans
J
J
Roy
A
A
Lewis
H
H
D000058:Accidental Falls; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D002648:Child; D005167:Factor VII / Q000627:therapeutic use; D005168:Factor VII Deficiency / Q000175:diagnosis* / Q000188:drug therapy; D015942:Factor VIIa; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology*; D006406:Hematoma / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000627:therapeutic use; D012861:Skating; D016896:Treatment Outcome
D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa