Bleeding tendency as a first symptom in children with congenital biliary dilatation.
OBJECTIVE
Although a bleeding tendency as a first symptom is a critical condition in congenital biliary dilatation (CBD), the clinical details of this symptom remain unclear. We assessed this condition in children with CBD in this paper.


METHODS
Sixty-five children with CBD were treated at our institute between 1983 and 2004. The children, initially presenting with bleeding manifestations such as intracranial hemorrhage and bloody stools, were defined as the bleeding group, and the remaining children with digestive symptoms such as abdominal pain and vomiting were defined as the digestive group. The clinical features were compared between these two groups.


RESULTS
In 6 of the 65 cases, bleeding manifestations were noted (9.2 %). All six had cystic-type choledochal dilatation. The mean age of the bleeding group was significantly younger than that of the digestive group, and bleeding was more frequent, especially in infants less than 12 months of age. In a laboratory study, the bleeding group showed a more prolonged blood coagulation time than the digestive group did. Serum amylase and lipase levels in the bleeding group were almost normal, while those in the digestive group were significantly higher. The direct bilirubin level in the bleeding group was significantly higher than that in the digestive group.


CONCLUSIONS
Disturbed blood coagulation due to vitamin K deficiency related to cholestasis results in a bleeding tendency in children with CBD. Therefore, pediatric surgeons should be aware of this rare but critical condition which can be prevented by rapid and precise treatment with vitamin K supplementation.
Fumino
S
S
Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan. fumin@koto.kpu-m.ac.jp
Iwai
N
N
Deguchi
E
E
Shimadera
S
S
Iwabuchi
T
T
Nishimura
T
T
Ono
S
S
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001649:Bile Duct Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014812:Vitamin K / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D014812:Vitamin K