ABSTRACT
Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Esophageal and Gastric Varices/therapy , Sclerotherapy/methods , Cyanoacrylates/therapeutic use , Balloon Occlusion/methods , Gastrointestinal Hemorrhage/therapy , Portal Vein , Portacaval Shunt, Surgical , Esophageal and Gastric Varices/complications , Reproducibility of Results , Treatment Outcome , Fatal Outcome , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/complicationsABSTRACT
Cardiogenic shock secondary to acute myocardial infarction unveils a systemic inflammatory response with elevation of cytokines that contribute to hypoperfusion. High volume hemofiltration may remove cytokines in patients with septic shock resulting in hemodynamic improvement and reducing the requirements of norepinephrine. We report a 48 year-old male with cardiogenic shock secondary to acute myocardial infarction who presented a systemic inflammatory response characterized by fever and hemodynamic collapse, without evidence of infection. Its hemodynamic profile was stabilized with high volume hemofiltration.