Octreótido de liberación prolongada para el tratamiento de hemorragia digestiva alta en Pediatría / Long-acting Release Octreotide for Pediatric Upper Gastrointestinal Bleeding

Resumen: Introducción: La hemorragia digestiva por hipertensión portal, sin alternativa de tratamiento endos- cópico o quirúrgico por localizaciones ectópicas, no identificadas del sitio de sangrado o caracterís ticas anatómicas, constituye un desafío terapéutico en Pediatría. El tratamiento habitual incluye la infusión de octreótido endovenoso. En los últimos años, la presentación de octreótido de liberación prolongada (OCT-LAR) para administración mensual intramuscular, resulta una alternativa tera péutica atractiva. Objetivo: Reportar el caso de un lactante con hemorragia digestiva por hiperten sión portal que recibió tratamiento exitoso con OCT-LAR. Caso Clínico: Paciente de 8 meses de vida, con malformación de vena porta extrahepática y episodios reiterados de sangrados digestivos con re querimientos transfusionales e infusiones de octréotido, sin posibilidad de tratamiento endoscópico o quirúrgico. Indicamos OCT-LAR intramuscular mensualmente. Después de diez meses de iniciado el tratamiento, el paciente no repitió sangrados digestivos y no presentó efectos adversos relacionados a la medicación. Conclusión: Consideramos que el reporte de este caso puede resultar de utilidad al presentar una nueva alternativa para el tratamiento de pacientes pediátricos con sangrado digestivo por hipertensión portal sin posibilidades terapéuticas convencionales.

Abstract: Introduction: Upper gastrointestinal bleeding (UGIB) secondary to portal hypertension (PHT), without endoscopic or surgical treatment options due to an ectopic or unidentified bleeding site or the patient's anatomic characteristics, is challenging in pediatric hepatology. The usual treatment in these cases includes intravenous Octreotide. Recently, the availability of long-acting release Octreo tide (OCT-LAR) for monthly intramuscular administration has become an interesting therapeutic alternative. Objective: To report the case of an infant with UGIB due to PHT who was successfully treated with OCT-LAR. Clinical Case: Eight-month-old patient with repeated episodes of UGIB due to extrahepatic portal vein malformation, requiring blood transfusions, and intravenous octreotide infusions. As neither endoscopic nor surgical treatment were feasible, we decided to start IM OCT- LAR monthly. After ten months of treatment, the patient did not present bleeding episodes. No medication-related events were observed. Conclusion: We consider that this report could help in the management of similar pediatric patients with UGIB due to PHT without conventional therapeutic possibilities.

Tuberculosis of the Duodenum: Clinical presentation, diagnosis and outcome.

Buck&round: Duodenal tuberculosis accounts for <2% of abdominal tuberculosis and usually manifests with recurrent vomiting. Existing guidelines suggest surgery as the mainstay for both obtaining a definitive diagnosis as well as for therapy. Aims: The aim of this prospective study was to describe the clinical presentation and usefulness of endoscopic techniques in the diagnosis and treatment of duodenal tuberculosis. Methods: Data of patients diagnosed to have duodenal tuberculosis over a three-year-period were analysed for age, presenting symptoms and outcome of therapy. Diagnosis was based on histological evidence of granulomatous inflammation along with unequivocal improvement in vomiting and other symptoms over six-eight weeks following a combination of anti-tubercular drug therapy and endoscopic balloon dilatation. Results: Ten patients with recurrent vomiting (median age 27 years) were diagnosed to have duodenal tuberculosis. Significant narrowing was seen at endoscopy in nine patients with post bulbar area being the commonest site in five patients. Histological diagnosis of granulomatous duodenitis was possible in nine (90%) patients. Balloon dilatation achieved resumption of normal diet at a median duration of seven days (range 2-40). Symptomatic improvement was substantiated by a median increase in BMI of 5 kg/m2 over the baseline value. Surgical intervention was not required in any patient. Conclusions : Recurrent vomiting due to gastric outlet obstruction is the commonest presentation of duodenal tuberculosis. Endoscopically, a histological diagnosis of granulomatous inflammation can be achieved in most of the patients. Endoscopic balloon dilatation coupled with anti-tubercular drug therapy is safe and effective treatment for this uncommon disease.