A Patient of Crohn’s Disease who Developed Coagulopathy Induced by Vitamin K Deficiency Early after Surgery for Stenosis of the Small Intestine

Abstract

The patient was a 38-year-old woman who had been diagnosed as having ileocolic Crohn's disease in 1994 and undergone resection of the ileocecal region and a part of the small intestine for ileal stenosis in 2004; the length of her residual small intestine was 230 cm. As symptoms of intestinal stenosis occurred despite postoperative medical therapy, in 2014, the patient was treated conservatively for 3 month, being prescribed exclusive intake of enteral formulas, followed by partial resection of the small intestine, including the anastomotic site of the previous operation. Prophylactic antibiotics were used only on the day of the surgery. While the preoperative blood tests showed no abnormalities of the coagulation profile, the PT and APTT were mildly prolonged one day after the surgery and markedly prolonged 6 days after the surgery (PT 72.8 seconds, APTT 98.3 seconds). Vitamin K deficiency was suspected, although there were no clinical symptoms. Her coagulation ability improved rapidly after intravenous infusion of a vitamin K preparation. Patients with Crohn's disease have multiple risk factors for vitamin deficiencies; however, virtually no previous reports have documented vitamin K deficiency-induced coagulopathy that appeared perioperatively. We report a case of vitamin K deficiencyinduced coagulopathy that occurred in the early postoperative period.