Bleeding Tendency in an Adolescent with Chronic Small Bowel Obstruction

慢性小腸阻塞的青少年其出血傾向

Chonnikant Visuthranukul ； Voranush Chongsrisawat ； Paisarn Vejchapipat ； Sirinuch Chomtho

《Asia Pacific Journal of Clinical Nutrition》 21卷4期 (2012/12) Pp. 642-647

https://doi.org/10.6133/apjcn.2012.21.4.21

摘要

本文報告一位慢性十二指腸阻塞的14歲男孩，顯現脂溶性維生素缺乏的病例。病患有周期性不明原因的出血傾向。檢驗結果顯示糞便中有脂肪球及特別長的凝血酶原時間。進一步檢查發現低血漿維生素A及偵測不到維生素E。在靜脈維生素K及口服維生素A及E補充後，這些異常症狀消失，但他仍然缺乏膝反射。可能長時間的十二指腸阻塞進而誘導細菌過度生長以致膽酸早期解離，使得脂肪吸收不良及脂溶性維生素缺乏。儘管此類病例報告很少，患有慢性小腸阻塞的病人，有必要做脂肪吸收不良及脂溶性維生素缺乏的檢測。

關鍵字

出血傾向 ； 脂溶性維生素缺乏 ； 維生素K缺乏 ； 小腸阻塞 ； 盲環症候群

並列摘要

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.

並列關鍵字

bleeding tendency ； fat-soluble vitamin deficiency ； vitamin K deficiency ； small bowel obstruction ； blind loop syndrome