Diagnostic Dilemma


A 5 years old boy with congenital temporo-mandibular joint ankylosis was operated for same following which he developed fever 8 days post-operatively with 2 episodes of hematemesis. There was no jaundice or bleeding from any other site in the past. On examination heart rate was 120, min, respiratory rate was 30, min and blood pressure was 90, 60 min of Hg. There was no icterus. He had splenomegaly and other systems were normal. Investigations showed hemoglobin of 10.3 gm, dl, WBC count of 4,400, cumm and platelets of 1,16,000, cumm with bilirubin of 10.7 mg, dl, SGOT of 72 IU, L and SGPT of 145 IU, L. His prothrombin time was 15.2 sec and partial thromboplastin time was More than 2 mins and serum Albumin was 2.8 gm, dl. Ultrasound abdomen with colour doppler showed mild hepatomegaly with altered echotexture and few intrahepatic and peri-gallbladder varices. HBsAg, Hepatitis A antibody and hepatitis E antibody were negative. Dengue IgM was positive. His CT angiography showed replacement of portal and splenic vein with numerous collaterals. He was treated with fresh frozen plasma, vitamin K, Vasopressin and antacids but his hematemesis persisted. Esophageogastroscopy was not possible due to surgery on temporo-mandibular joint.

How to control the hematemesis in this child_?
Expert Opinion :
Though the child had portal hypertension, his episode of hematemesis also coincided with acute dengue infection. Thus apart from portal hypertension, bleeding could also be related to coagulopathy and thrombocytopenia due to dengue. This child thus was additionally given platelet and FFP transfusion and his hematemesis subsided. He then underwent Esophageogastroscopy after one month of surgery.
Answer Discussion :
huda esoulc
factor 8
11 years ago
Ramessur Ramtohul
ice water lavage
11 years ago

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