[P-05] Fatal spontaneous intraluminal intestinal haematoma: a paediatric case report
Mana Taweevisit1,2 and Paul Scott Thorner1,3
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Thailand
- King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Thailand
- Department of Pathology and Laboratory Medicine, Hospital for Sick Children and University of Toronto, Canada
Background: Disseminated intravascular coagulation (DIC) is the excessive activation of the coagulation pathway with thrombus formation, progressing to a consumptive coagulopathy with an imbalance between the fibrinolytic and antifibrinolytic systems, resulting in uncontrolled haemorrhage. Sepsis is the most common condition associated with DIC, usually manifesting as diffuse bleeding, commonly involving the gastrointestinal tract. However, intraluminal intestinal haematoma leading to obstruction is rare, and such patients usually improve with management. We report what we believe is the first case of a fatal intraluminal intestinal hematoma in an infant with DIC.
Case Presentation: An 11-month-old boy was admitted to the intensive care unit with pneumonia and severe respiratory distress syndrome, associated with septic shock and DIC. Ten days after admission, a 10-cm abdominal mass was detected in the right lower quadrant. Ultrasound showed a markedly thickened and oedematous bowel wall interpreted as severe acute enterocolitis. The patient died two days later. At autopsy, there was generalised bowel distension with an intraluminal haematoma extending from the jejunum to the ascending colon. No point of bleeding could be identified. There was a perforation in the terminal ileum at a site of transmural necrosis, considered to be secondary to pressure ischaemia from the haematoma.
Discussion and Conclusion: Spontaneous intraluminal haematoma is a rare cause of small bowel obstruction. Patients with DIC are at risk for this event and the smaller bowel lumen in children makes them especially at risk for obstruction. Prompt recognition of this condition is crucial for a successful patient outcome.
