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Subject

Subdural Hemorrhage Related to Vitamin K Deficiency in an Infant with Choledochal Cyst
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논문 기본 정보

Type
Academic journal
Author
Sohyung Park (국립과학수사연구원) Jang-Gyu Cha (순천향대학교) Byung-Ha Choi (국립과학수사연구원)
Journal
대한법의학회 대한법의학회지 대한법의학회지 제44권 제4호 KCI Accredited Journals
Published
2020.1
Pages
163 - 168 (6page)

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Subdural Hemorrhage Related to Vitamin K Deficiency in an Infant with Choledochal Cyst
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The deceased was a 6-month-old male infant who was transferred to the hospital due to jaundice and vomiting. During admission, subdural hemorrhage and retinal hemorrhage were observed; additionally, a rib fracture was identified on the previous radiography images, which had eventually healed by the time of the follow-up study. This case was reported to the police, alleging child abuse, which led to a medicolegal dispute between the hospital and the deceased's parents. In addition, bleeding tendency and coagulopathy related to vitamin K deficiency were also found. The past history revealed that the deceased had diarrhea, jaundice, and experienced several episodes of acholic stools, and low levels of vitamin D at birth. On postmortem examination, the brain already revealed liquefactive necrosis, but subdural hemorrhage was still observed. The optic nerves of both eyes revealed hemorrhage with focal retinal hemorrhage. No definite fracture was identified; however, osteopenia was observed in the long bones. The liver showed septal fibrosis and cholestasis which is nearly biliary cirrhosis, and mild dilation of the intrahepatic and extrahepatic bile ducts, suggesting a choledochal cyst. This case illustrates that subdural hemorrhage related to vitamin K deficiency could occur in an infant with a choledochal cyst. When subdural hemorrhage is encountered in a child with what is considered an intentional head injury, the possibility of spontaneous hemorrhage should be excluded.

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