A Case of Prolonged Bleeding of the Tongue in a Patient with the Kasabach-Merritt Syndrome

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  • 舌出血をくり返したKasabach-Merritt症候群の男児の1例

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Abstract

A 12-year-old boy bit his tongue inadvertently while eating, and experienced prolonged bleeding of the tongue for four days. He was referred to the Division of Dentistry, Chiba Children's Hospital, because of persistent mucosal bleeding of the tongue. Hemangioma existed over a wide range on his trunk and left upper limb. He had been diagnosed as having the Kasabach-Merritt syndrome. The blood platelet count was 11.4×104/μl at his first medical examination, and other blood solidification system tests showed disseminated intravascular coagulation syndrome (DIC).<BR>The tongue wound was repaired using 4-0 Nylon sutures and the bleeding was arrested.<BR>However, the tongue started bleeding the next day, and he was admitted to the Division of Hematology because of the bleeding and eating disorder. Carbazochrome sodium sulfonate and tranexamic acid were administered systemically, but the bleeding persisted, so that suturing of the tongue was required again two days later. Despite the suture having been placed twice, bleeding from the tongue occurred the day after. The wound was closed by 4-0 Nylon sutures and a continuous intravenous infusion of heparin was started. After that, there was no bleeding for six days, so the sutures were removed and the patient was discharged.<BR>In the case of DIC, hemostasis is difficult when the blood platelet count is more than 5×104/μl. Before performing an oral surgery, it should be kept in mind that a patient with a large hemangima may have DIC.

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