WK Kwok, NSY Chao, MWY Leung, pmy Tang, bpy Wong, LC Ho, kkw Liu

Abstract

A two-day-old full-term baby presented with vomiting and distended abdomen with a right-lower-quadrant mass. He had severe thrombocytopenia without sepsis. Radiograph showed dilated bowels displaced to the left side. Contrast enema showed micro-colon. Sonogram revealed a vascular lesion involving bowels. Laparotomy proceeded on day three for persistent obstruction: a large angiomatous lesion was found encroaching on distal ileum. Profuse haemorrhage forbade dissection; temporising ileostomy was performed. Obtruction was relieved but thrombocytopenia persisted. After ten days of supportive treatment and follow-up vascular imaging, the second operation proceeded; the intestine and mesentery bearing the lesion were resected. The baby recovered and thrived well; ileostomy was soon closed before discharging home. Histology revealed mesenteric Kaposiform haemangioendothelioma. This is a rare report of such lesion with extensive intestinal involvement causing life-threatening intestinal obstruction and coagulopathy in a newborn, necessitating urgent surgical resection. Although the baby recovered from operation, significant intestinal length was resected and resection margins were involved: post operative surveillance is needed to monitor nutrition and possible tumour recurrence.