論文

査読有り 国際誌
2012年9月10日

Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia.

Forensic science international
  • Masashi Miyao
  • ,
  • Hitoshi Abiru
  • ,
  • Munetaka Ozeki
  • ,
  • Hirokazu Kotani
  • ,
  • Tatsuaki Tsuruyama
  • ,
  • Naho Kobayashi
  • ,
  • Tadaki Omae
  • ,
  • Toshio Osamura
  • ,
  • Keiji Tamaki

221
1-3
開始ページ
e25-9
終了ページ
E29
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1016/j.forsciint.2012.04.018
出版者・発行元
ELSEVIER IRELAND LTD

Extrahepatic biliary atresia (EHBA) is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin K deficiency bleeding (VKDB) due to cholestasis-induced fat malabsorption. Breast feeding increases the tendency of bleeding in EHBA patients because breast milk contains low amounts of vitamin K. A 2-month-old female infant unexpectedly died, with symptoms of vomiting and jaundice prior to death. She had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding. There was no history of trauma. She received vitamin K prophylaxis orally. In an emergency hospital, a CT scan showed a right intracranial hematoma and mass effect with midline shift to the left. In the postmortem examination, severe atresia was observed in the whole extrahepatic bile duct. Histologically, cholestasis, periductal fibrosis, and distorted bile ductules were noted. The gallbladder was not identified. A subdural hematoma and cerebellar tonsillar herniation were found; however, no traumatic injury in any part of the body was observed. Together, these findings suggest that the subdural hemorrhage was caused by secondary vitamin K deficiency resulting from a combination of cholestasis-induced fat malabsorption and breastfeeding. Subdural hemorrhage by secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued. This case demonstrated that intrinsic factors, such as secondary VKDB (e.g., EHBA, neonatal hepatitis, chronic diarrhea), should also be considered in infant autopsy cases presenting with subdural hemorrhage.

リンク情報
DOI
https://doi.org/10.1016/j.forsciint.2012.04.018
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/22607980
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000306967300007&DestApp=WOS_CPL
ID情報
  • DOI : 10.1016/j.forsciint.2012.04.018
  • ISSN : 0379-0738
  • PubMed ID : 22607980
  • Web of Science ID : WOS:000306967300007

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