A Case of Open Intragastric Hematoma Removal Surgery in a Neonate With Vitamin K Deficiency Bleeding

Abstract

The patient was a 1-day-old boy born by natural childbirth at 41 weeks and 0 days of gestation. He developed hematemesis 19 h after birth. H₂ blockers and vitamin K2 were administered, but there was no improvement. He was transferred to our neonatal intensive care unit. He was pale and had respiratory distress due to epigastric distention. He was intubated, and ventilatory management was started. About 15 ml of fresh blood was aspirated from the nasogastric tube. Blood tests showed anemia and prolonged prothrombin time. In addition, an upper gastrointestinal series revealed a massive intragastric hematoma, suggesting impending gastric rupture. We performed emergency surgery. When we opened the abdomen, there was no discoloration of the gastric wall or serous membrane damage, but the stomach was tense with a large amount of coagulum. We removed the coagulum and placed a gastrostomy. On the basis of his clinical course, intraoperative findings, and postoperative findings of a high PIVKA-II level on admission, we diagnosed the patient as having neonatal melena due to vitamin K deficiency bleeding (VKBD). The postoperative course was good, and the patient was discharged from the hospital 17 days after surgery. Although VKBD generally improves with conservative treatment, in the present case, gastrointestinal bleeding resulted in the formation of a massive intragastric hematoma and raised concern for impending gastric rupture. Repeated evaluation of the patient’s general condition is necessary for carefully determining a treatment plan for VKBD.