Uncorrectable coagulopathy due to intestinal obstruction: A clinical dilemma of competing priorities in a child

Abstract

Disseminated intravascular coagulation (DIC) is a contraindication for major surgical operations. However, if surgery is required to correct the underlying cause of DIC, a clinical confl ict is created. In such complex scenario, standard resources such as textbooks and journals offer very little guidance. In this communication, we report a 22-month-old boy who developed sepsis-induced DIC following intestinal obstruction.  Pre-operative attempts to normalize coagulation parameters failed.  Damage control laparotomy was undertaken as it was considered essential to control the underlying cause of DIC. His abnormal coagulation status  reverted quickly after surgical relief of intestinal obstruction. Paradoxically
intraoperative blood loss was less than anticipated amount. There are a few case reports of adult patients who have successfully undergone major  surgery despite the presence of abnormal coagulation. However, this appears to be the fi rst paediatric report of successful surgery in DIC status. Lessons learnt from this case and hypothetical speculations of clinical paradoxes are discussed.

Key words: Anaesthesia in coagulopathy, bleeding disorder, coagulopathy, damage control surgery, disseminated intravascular coagulation, intra-operative bleeding, paediatric age, sepsis