HEMORRAGIA DIGESTIVA ALTA ASOCIADA A DEFICIENCIA GRAVE DE VITAMINA K SECUNDARIA A COLESTASIS OBSTRUCTIVA POR COLEDOCOLITIASIS: REPORTE DE CASO
Creators
- 1. Universidad Santiago de Cali Facultad de Salud
- 2. Clínica Los Nevados
- 3. Universidad Tecnológica de Pereira, Risaralda, Colombia
- 4. Universidad Metropolitana de Barranquilla, Barranquilla, Colombia.
Description
La hemorragia digestiva alta (HDA) constituye una de las emergencias más comunes en medicina interna y gastroenterología, siendo generalmente causada por úlceras pépticas, hipertensión portal o lesiones erosivas de la mucosa gástrica. No obstante, en escenarios menos frecuentes, puede originarse por alteraciones de la coagulación. La deficiencia de vitamina K secundaria a colestasis obstructiva es una causa rara pero clínicamente relevante, ya que compromete la síntesis de factores de coagulación dependientes de vitamina K y puede desencadenar sangrados graves. El objetivo de este reporte es describir un caso de HDA secundaria a deficiencia severa de vitamina K en el contexto de coledocolitiasis obstructiva y discutir sus implicaciones diagnósticas y terapéuticas. Para el análisis se realizó una revisión narrativa de la literatura en PubMed, Scopus y Web of Science, priorizando reportes de caso, revisiones y estudios sobre deficiencia de vitamina K asociada a obstrucción biliar. Los hallazgos muestran que, aunque infrecuente, esta entidad debe sospecharse en pacientes con ictericia obstructiva y alteraciones de la coagulación sin trombocitopenia ni hipofibrinogenemia. La reposición temprana de vitamina K intravenosa y la resolución de la causa obstructiva mediante CPRE constituyen intervenciones clave para revertir la coagulopatía y prevenir recurrencias. En conclusión, la identificación temprana de este mecanismo fisiopatológico y el abordaje multidisciplinario son determinantes para mejorar la supervivencia en estos pacientes.
Abstract (English)
Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies in internal medicine and gastroenterology, typically caused by peptic ulcers, portal hypertension, or erosive lesions of the gastric mucosa. However, in less frequent scenarios, it may arise from coagulation disorders. Vitamin K deficiency secondary to obstructive cholestasis is a rare but clinically significant cause, as it impairs the synthesis of vitamin K–dependent clotting factors and may trigger severe bleeding. The aim of this report is to describe a case of UGIB secondary to severe vitamin K deficiency in the context of obstructive choledocholithiasis and to discuss its diagnostic and therapeutic implications. For this analysis, a narrative literature review was conducted in PubMed, Scopus, and Web of Science, prioritizing case reports, reviews, and studies addressing vitamin K deficiency associated with biliary obstruction. Findings show that although uncommon, this condition should be suspected in patients with obstructive jaundice and coagulation abnormalities in the absence of thrombocytopenia or hypofibrinogenemia. Early intravenous vitamin K replacement and resolution of the obstructive cause through ERCP are key interventions to reverse coagulopathy and prevent recurrence. In conclusion, early recognition of this pathophysiological mechanism and a multidisciplinary approach are crucial to improving survival in these patients.
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Additional details
Additional titles
- Translated title (English)
- UPPER GASTROINTESTINAL BLEEDING ASSOCIATED WITH SEVERE VITAMIN K DEFICIENCY SECONDARY TO OBSTRUCTIVE CHOLESTASIS DUE TO CHOLEDOCHOLITHIASIS: A CASE REPORT
Identifiers
- ISSN
- 2530-5468
Dates
- Submitted
-
2025-08-25
- Accepted
-
2025-09-22
Software
- Repository URL
- https://revistacientificasanum.com/
References
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