Résumé
Transjugular intrahepatic portasystemic shunt (TIPS) is a procedure that inserts an expandable metallic stent into the liver parenchyme by transjugular catheterization. During the past decade, TIPS has been accepted as an alternative to the surgical shunt procedure for controlling the complications of portal hypertension and has become more widely performed. Complications of TIPS include encephalopathy, bleeding, deterioration of liver function and infection. Although periprocedual sepsis has been known since the early days of TIPS stenting, infection by the TIPS device itself has only recently been recognized because of its rare occurrence. The definition of endotipsitis makes it possible to classify it into two groups: definite and probable infection. We report a case of probable endotipsitis with relapsing bacteremia after TIPS for uncontrolled varix bleeding. If relapsing bacteremia without any other clearly attributable source occurs in a patient with TIPS, the possibility of endotipsitis is considered.
Sujets)
Humains , Bactériémie , Cathétérisme , Cathéters , Hémorragie , Hypertension portale , Foie , Anastomose chirurgicale portosystémique , Anastomose portosystémique intrahépatique par voie transjugulaire , Sepsie , Endoprothèses , VaricesRésumé
Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl(R) and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl(R) injection therapy with a review of literatures.
Sujets)
Colle de fibrine , Fistule , Radiothérapie , Adhésifs tissulaires , TuberculoseRésumé
Henoch-Schonlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits affecting small vessels in the skin, joint, gastrointestinal tract, and kidneys. Gastrointestinal symptoms are common and may precede the appearance of characteristic skin rash. These manifestations include abdominal pain, bleeding, bowel infarction, intussusception, or even, perforation. However, hemorrhagic ascites has been rarely described in patients with HSP. The pathophysiologic mechanism is presumably a vasculitis of the small vessels within the serosa. We report a 37-year-old man with HSP complicated by hemorrhagic ascites. Contrast CT of the abdomen showed extensive bowel wall thickening and ascites. A paracentesis yielded hemorrhagic fluid. These abdominal manifestations were improved after methylprednisolone pulse therapy.