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

Sohyung Park, J. Cha, B. Choi
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Abstract

Subdural hemorrhage with retinal hemorrhage in infancy is a common finding that is usually observed in cases of abusive head trauma [1,2]. If a subdural hemorrhage is observed on postmortem examination or clinical image study in a pediatric case, the possibility of child abuse should be considered and the attending physician has a legal obligation to report a suspected child abuse case to the police or the National Center for the Right of the Child. However, given that subdural hemorrhage can also occur in metabolic disorders, clotting disorders, and in other medical conditions [1,2], subdural hemorrhage encountered in a pediatric case should not be automatically considered as head trauma, and it is necessary that the case be meticulously and cautiously reviewed. We experienced a rare case in which the possibility of child abuse was initially suspected, but later considered as spontaneous subdural hemorrhage related to vitamin K deficiency in an infant with a choledochal cyst. Korean J Leg Med 2020;44:163-168 https://doi.org/10.7580/kjlm.2020.44.4.163
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婴儿胆总管囊肿与维生素K缺乏有关的硬膜下出血
婴儿期硬膜下出血合并视网膜出血是一种常见的发现,通常在虐待性头部创伤病例中观察到[1,2]。如果在儿童病例的尸检或临床影像研究中观察到硬膜下出血,应考虑虐待儿童的可能性,主治医生有法律义务向警方或国家儿童权利中心报告疑似虐待儿童的案件。然而,考虑到硬膜下出血也可能发生在代谢障碍、凝血障碍和其他医疗条件下[1,2],在儿科病例中遇到硬膜下出血不应自动认为是头部创伤,有必要对病例进行仔细和谨慎的审查。我们经历了一个罕见的病例,最初怀疑儿童虐待的可能性,但后来认为是自发性硬膜下出血与维生素K缺乏有关的胆总管囊肿婴儿。韩国医学杂志2020;44 (4):163-168 https://doi.org/10.7580/kjlm.2020.44.4.163
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