An unusual complication of ice skating and the emergence of a previously undiagnosed bleeding disorder

Summary.  We report the case of an 8‐year‐old boy with no prior abnormal bleeding history who presented with severe central abdominal pain following a freak accident at a local ice rink. Clinical examination confirmed a tender periumbilical mass. An ultrasound scan confirmed a large haemorrhagic fluid collection adjacent to the second part of his duodenum that was causing a subacute small‐bowel obstruction. He was found to have a persistently prolonged prothrombin time between 17.3 and 18.1 s but normal liver function tests. There was no suggestion of dietary vitamin K deficiency. Further investigations confirmed factor VII deficiency with levels between 30.4 and 33.6 IU dL −1 . His prothrombin time did not normalize with intravenous vitamin K. He was subsequently treated with three 30  μ g kg −1 body weight doses of novoseven at 4‐h interval and made an excellent recovery. The haematoma virtually resolved completely confirmed by a follow‐up ultrasound scan 3 months after the initial event.