A case of vitamin K deficiency associated massive hemorrhage 3 days after endoscopic sphincterotomy

Abstract

A 54-year-old woman was admitted to our hospital because of obstructive jaundice due to cholecysto-choledocholithiasis. Gallstones were extracted from the common bile duct and cystic. duct immediately after endoscopic sphincterotomy (EST) using a wire basket. Endoscopic procedure was completed without any hemorrhage. However, massive hemorrhage from the papilla of Vater occurred suddenly 3 days after EST. Prothrombin time and hepaplastin test values were 17.9 and 2.4%, respectively, indicating severe clotting abnormalities. Vitamin K is required for blood-coagulation regulation, and its depeletion due to antibiotic therapy as an example results in a bleeding tendency. Since its involvement was considered in the present case, the antibiotic administration was interrupted and vitamin K was intravenously infused. Conseuently hemostasis was immediately obtained. It should be kept in mind that vitamin K absorption in obstructive jandice is disturbed because bile salts reuired for absorption fail to enter the intestine. Therefore, before and after EST of patients with obstructive janudice and/or administration of antibiotics, coagulation status must be assessed taking possible vitamin K deficiency into account.