title: Bleeding tendency in an adolescent with chronic small bowel obstruction.
abstract: We report a case of fat-soluble vitamin deficiency in a 14-year old boy who had chronic duodenal obstruction. He presented with periodic unexplained bleeding tendency. The laboratory results showed positive fat globules in stool and prolonged prothrombin time. His further investigation revealed low plasma vitamin A and undetectable plasma vitamin E. After parenteral vitamin K and oral vitamin A and E supplement, these abnormalities resolved although he still had absent knee jerk. We propose that fat malabsorption and fat-soluble vitamin deficiency can occur after prolonged duodenal obstruction that induce bacterial overgrowth following by bile acid deconjugation. Despite very few case reports, screening for fat malabsorption and fat-soluble vitamin deficiency might be warranted in patients with chronic small bowel obstruction.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. deknet@gmail.com
authors.forename: Chonnikant
authors.initials: C
authors.lastname: Visuthranukul
authors.forename: Voranush
authors.initials: V
authors.lastname: Chongsrisawat
authors.forename: Paisarn
authors.initials: P
authors.lastname: Vejchapipat
authors.forename: Sirinuch
authors.initials: S
authors.lastname: Chomtho
mesh_terms: D000293:Adolescent; D057210:Delayed Diagnosis; D004380:Duodenal Obstruction / Q000601:surgery*; D015390:Gastric Bypass / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012086:Reoperation / Q000009:adverse effects; D045602:Steatorrhea / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage / Q000627:therapeutic use; D014813:Vitamin K Deficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*
chemical_list: D014812:Vitamin K