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1.
Einstein (Säo Paulo) ; 18: eRC4934, 2020. graf
Article Dans Anglais | LILACS | ID: biblio-1056036

Résumé

ABSTRACT Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


RESUMO O sangramento gastrointestinal varicoso está entre as maiores causas de morbimortalidade nos paciente com doença hepática crônica. O tratamento endoscópico é a primeira linha terapêutica neste pacientes, porém naqueles que apresentam falha nesta modalidade terapêutica, o amplo conhecimento de opções alternativas de tratamento pode melhorar o prognóstico. Descrevemos um caso de paciente submetido à embolização com sucesso de varizes gastresofágicas por acesso transesplênico.


Sujets)
Humains , Femelle , Adulte , Veine liénale/chirurgie , Varices oesophagiennes et gastriques/chirurgie , Embolisation thérapeutique/méthodes , Hémorragie gastro-intestinale/chirurgie , Veine porte/chirurgie , Veine liénale/imagerie diagnostique , Angiographie/méthodes , Varices oesophagiennes et gastriques/imagerie diagnostique , Tomodensitométrie/méthodes , Résultat thérapeutique , Échographie-doppler/méthodes , Thrombose veineuse/chirurgie , Hémorragie gastro-intestinale/imagerie diagnostique
2.
Annals of Surgical Treatment and Research ; : 101-106, 2019.
Article Dans Anglais | WPRIM | ID: wpr-739577

Résumé

PURPOSE: This study compared the patency of the splenic vessels between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy. METHODS: We retrospectively reviewed a database of 137 patients who underwent laparoscopic (n = 91) or open (n = 46) spleen and splenic vessel-preserving distal pancreatectomy at a single institute from 2001 through 2015. Splenic vessel patency was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis. RESULTS: The splenic artery patency rate was similar in both groups (97.8 vs. 95.7%, P = 0.779). Also, the splenic vein patency rate was not significantly different between the 2 groups (74.7% vs. 82.6%, P = 0.521). Postoperative wound complication was significantly lower in the laparoscopic group (19.8% vs. 28.3%, P = 0.006), and hospital stay was significantly shorter in the laparoscopic group (7 days vs. 9 days, P = 0.001) than in the open group. Median follow-up periods were 22 months (3.7–96.2 months) and 31.7 months (4–104 months) in the laparoscopic and open groups, respectively. CONCLUSION: Laparoscopic distal pancreatectomy showed good splenic vessel patency as well as open distal pancreatectomy. For this reason, splenic vessel patency is not an obstacle in performing laparoscopic splenic vessel-preserving distal pancreatectomy.


Sujets)
Humains , Sténose pathologique , Études de suivi , Laparoscopie , Durée du séjour , Pancréatectomie , Études rétrospectives , Rate , Artère splénique , Veine liénale , Degré de perméabilité vasculaire , Plaies et blessures
3.
Rev. gastroenterol. Perú ; 38(3): 280-284, jul.-set. 2018. ilus, tab
Article Dans Espagnol | LILACS | ID: biblio-1014095

Résumé

La enfermedad de Gaucher, es un trastorno autosómico recesivo de depósito lisosomal que se caracteriza por deficiencia de la beta-glucocerebrosidasa que lleva a la acumulación de glucosilceramida principalmente en células del sistema fagocítico mononuclear causando afectaciones sistémicas. Se presenta paciente varón de 20 años que cursa con dolor crónico en hipocondrio izquierdo con episodios de sangrados desde hace 3 años y sensación de alza térmica, al examen físico se identificó ictericia y esplenomegalia masiva, sin afectación neurológica. Como apoyo al diagnóstico se mostró osteoporosis severa, pancitopenia y como hallazgo inesperado la presencia de trombosis de vena porta con transformación cavernomatosa complicada con biliopatía portal simulando un tumor de klatskin, los estudios de médula y enzimáticos eran compatibles con enfermedad de Gaucher, por lo cual recibió tratamiento con imiglucerasa realizando seguimiento. Es un caso poco frecuente, de gran interés, heterogeneidad en sus manifestaciones clínicas e inéditas por su complicación, constituyendo un desafío llegar a su diagnóstico de esta enfermedad huérfana.


Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.


Sujets)
Humains , Mâle , Jeune adulte , Veine porte/malformations , Veine porte/anatomopathologie , Maladies des canaux biliaires/étiologie , Maladie de Gaucher/complications , Hémangiome caverneux/complications , Hémorragie gastro-intestinale/étiologie , Hypertension portale/complications , Veine porte/imagerie diagnostique , Veines rénales/anatomopathologie , Veines rénales/imagerie diagnostique , Splénectomie , Veine liénale/anatomopathologie , Veine liénale/imagerie diagnostique , Conduits biliaires intrahépatiques/anatomopathologie , Conduits biliaires intrahépatiques/imagerie diagnostique , Tomodensitométrie , Dilatation pathologique/étiologie , Thérapie enzymatique substitutive , Vésicule biliaire/vascularisation , Maladie de Gaucher/diagnostic , Maladie de Gaucher/traitement médicamenteux , Glucosylceramidase/usage thérapeutique , Hypertension portale/imagerie diagnostique , Veines mésentériques/anatomopathologie , Veines mésentériques/imagerie diagnostique
4.
Anatomy & Cell Biology ; : 232-235, 2018.
Article Dans Anglais | WPRIM | ID: wpr-718740

Résumé

Portal vein provides about three-fourths of liver's blood supply. Portal vein is formed behind the neck of pancreas, at the level of the second lumbar vertebra and formed from the convergence of superior mesenteric and splenic veins. The purpose of this study is to review the normal distribution and variation, morphometry of portal vein and its branches for their implication in liver surgery and preoperative portal vein embolization. It is also helpful for radiologists while performing radiological procedures. A total of fresh 40 livers with intact splenic and superior mesenteric vein were collected from the mortuary of Forensic Department, JSS Medical College and Mysuru Medical College. The silicone gel was injected into the portal vein and different segments were identified and portal vein variants were noted. The morphometry of portal vein was measured by using digital sliding calipers. The different types of portal vein segmental variants were observed. The present study showed predominant type I in 90% cases, type II 7.5% cases, and type III 2.5% cases. Mean and standard deviation (SD) of length of right portal vein among males and females were 2.096±0.602 cm and 1.706±0.297 cm, respectively. Mean and SD of length of left portal vein among males and females were 3.450±0.661 cm and 3.075±0.632 cm, respectively. The difference in the Mean among the males and females with respect to length of right portal vein and left portal vein was found to be statistically significant (P=0.010). Prior knowledge of variations regarding the formation, termination and tributaries of portal vein are very helpful and important for surgeons to perform liver surgeries like liver transplantation, segmentectomy and for Interventional Radiologists.


Sujets)
Femelle , Humains , Mâle , Transplantation hépatique , Foie , Mastectomie partielle , Veines mésentériques , Méthodes , Cou , Pancréas , Veine porte , Silicium , Silicone , Rachis , Veine liénale , Chirurgiens
5.
J. vasc. bras ; 16(1): f:43-l:47, Jan.-Mar. 2017. ilus
Article Dans Portugais | LILACS | ID: biblio-849080

Résumé

A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico


Portal vein thrombosis is a rare vascular cause of acute abdomen and it is directly related to hereditary or acquired thrombophilias. This article presents the case of a 60-year-old male patient, with clinical signs of mesenteric ischemia that was confirmed by imaging examination. He underwent enterectomy and enteroanastomosis and, after detection of portal vein thrombosis by splenoportography, he was prescribed drug-based treatment with continuous infusion of recombinant tissue plasminogen activator (Alteplase) via selective catheterization of the superior mesenteric artery. This is a treatment innovation. The portal system was successfully recanalized. However, the patient developed abdominal sepsis and required intensive care for 25 days. His clinical status improved and he was discharged with a prescription for oral anticoagulant. This article presents a brief review of the literature and a discussion of portal vein thrombosis


Sujets)
Humains , Mâle , Adulte d'âge moyen , Cathétérisme/méthodes , Artère mésentérique supérieure , Veine porte , Thrombose/thérapie , Abdomen aigu/diagnostic , Abdomen aigu/thérapie , Anticoagulants/usage thérapeutique , Ischémie mésentérique/diagnostic , Ischémie mésentérique/thérapie , Facteurs de risque , Veine liénale , Traitement thrombolytique/méthodes , Tomodensitométrie/méthodes
6.
Annals of Surgical Treatment and Research ; : 348-354, 2017.
Article Dans Anglais | WPRIM | ID: wpr-183537

Résumé

PURPOSE: It is believed that blood from the superior mesenteric vein and splenic vein mixes incompletely in the portal vein and maintains a streamline flow influencing its anatomic distribution. Although several experimental studies have demonstrated the existence of streamlining, clinical studies have shown conflicting results. We investigated whether streamlining of portal vein affects the lobar distribution of colorectal liver metastases and estimated its impact on survival. METHODS: Data of patients who underwent hepatectomy for colorectal liver metastases were retrospectively collected. The chi-square test was used for analyzing the distribution of metastasis. Cox analysis was used to identify risk factors of survival. Fisher exact test was used for subgroup analysis comparing hepatic recurrence. RESULTS: A total of 410 patients were included. The right-to-left ratio of liver metastases were 2.20:1 in right-sided colon cancer and 1.39:1 in left-sided cancer (P = 0.017). Cox analyses showed that margin < 5 mm (P < 0.001; 95% confidence interval [CI], 1.648–4.884; hazard ratio [HR], 2.837), age ≥ 60 years (P = 0.004; 95% CI, 1.269–3.641; HR, 2.149), N2 status (P < 0.001, 95% CI, 1.598–4.215; HR, 2.595), tumor size ≥ 45 mm (P = 0.014; 95% CI, 1.159–3.758; HR, 2.087) and other metastasis (P = 0.012; 95% CI, 1.250–5.927; HR, 2.722) were risk factors of survival. However, in 70 patients who underwent right hemihepatectomy for solitary metastasis, left-sided colorectal cancer was a risk factor (P = 0.019; 95% CI, 1.293–17.956; HR, 4.818), and was associated with higher recurrence than right-sided cancer (43.1% and 15.8%, respectively, P = 0.049). CONCLUSION: This study showed significant difference in lobar distribution of liver metastases between right colon cancer and left colorecral cancer. Furthermore, survival of left-sided colorectal cancer was poorer than that of right-sided cancer in patients who underwent right hemihepatectomy for solitary metastasis. These findings can be helpful for clinicians planning treatment strategy.


Sujets)
Humains , Tumeurs du côlon , Tumeurs colorectales , Hépatectomie , Foie , Veines mésentériques , Métastase tumorale , Veine porte , Récidive , Études rétrospectives , Facteurs de risque , Veine liénale
7.
Korean Journal of Pancreas and Biliary Tract ; : 72-76, 2017.
Article Dans Coréen | WPRIM | ID: wpr-192946

Résumé

Chronic pancreatitis is characterized by the progressive inflammation and irreversible fibrosis of pancreas causing pancreatic dysfunctions and various complications. The most common symptom is abdominal pain. In addition various complications such as pseudocyst, biliary or duodenal obstruction, pancreatic ascites, splenic vein thrombosis and pseudoaneurysm can develop according to the degree of inflammation or the progression of disease. So, management of chronic pancreatitis needs multidisciplinary approach in many cases. The treatment method can be divided into life style modifications, medications, endoscopic or radiological interventions and surgeries. In most cases, the specific treatments are recommended not only by the evidence-based guidelines but also by the experts' opinions due to the lack of randomized controlled trials with sufficient number of patients. Life style modifications and medication for the pain and the pancreatic exocrine insufficiency will be addressed in this section.


Sujets)
Humains , Douleur abdominale , Faux anévrisme , Ascites , Occlusion duodénale , Fibrose , Inflammation , Mode de vie , Méthodes , Pancréas , Pancréatite , Pancréatite chronique , Veine liénale , Thrombose
8.
Annals of Surgical Treatment and Research ; : 56-58, 2016.
Article Dans Anglais | WPRIM | ID: wpr-135115

Résumé

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.


Sujets)
Humains , Adulte d'âge moyen , Anévrysme , Prothèse vasculaire , Procédures endovasculaires , Études de suivi , Splénectomie , Veine liénale , Endoprothèses
9.
Annals of Surgical Treatment and Research ; : 56-58, 2016.
Article Dans Anglais | WPRIM | ID: wpr-135114

Résumé

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.


Sujets)
Humains , Adulte d'âge moyen , Anévrysme , Prothèse vasculaire , Procédures endovasculaires , Études de suivi , Splénectomie , Veine liénale , Endoprothèses
10.
Gastroenterol. latinoam ; 26(1): 24-29, ene.-mar. 2015. ilus
Article Dans Espagnol | LILACS | ID: lil-766829

Résumé

Upper gastrointestinal bleeding secondary to acute variceal hemorrhage is a medical emergency, with significant morbidity and mortality, which usually requires a multidisciplinary approach from gastroenterologists, intensive care physicians, and surgeons. The most common cause of variceal bleeding is the one that arises from portal hypertension associated with cirrhosis, and best described in terms of prevention, initial management and following treatment that in the minority of cases can be definitive without complex interventions, including liver transplant in cirrhotic patients. Within the etiologies not arising from portal hypertension, splenic vein thrombosis is one of the most important. Characterized by an endoscopic appearance of fundal or isolated gastric varices, without esophageal involvement, a variable number of cases manifest clinically as variceal hemorrhage. Based on different pathophysiology compared to esophageal varices, response to initial treatment is different, endoscopic management involve the use of adhesives (e.g. cyanoacrylate) as treatment of choice, and, in selected cases, surgical treatment can provide a definitive solution. Here we present a clinical case of an adult patient, without history of cirrhosis, who presented to the emergency department with severe upper gastrointestinal bleeding secondary to gastric varices, admitted in Intensive Care Unit and treated with endoscopy. Complementary studies with abdominal CT showed spleen vein thrombosis, enlarged spleen and multiple varicesin gastric body and fundus. After stabilization, splenectomy was performed as definitive treatment, with regression of gastric varices on ambulatory control with an upper endoscopy...


La hemorragia digestiva alta por sangrado variceal agudo constituye una emergencia médica, con morbimortalidad significativa asociada, requiriendo manejo multidisciplinario de gastroenterólogos, intensivistas y cirujanos. El sangrado variceal por hipertensión portal secundario a daño hepático crónico es el más habitual y mejor caracterizado en prevención, enfrentamiento inicial y manejo posterior, que en la minoría de los casos puede ser definitivo, sin intervenciones complejas, incluyendo trasplante hepático en pacientes cirróticos. Dentro de las causas de sangrado variceal no asociadas a hipertensión portal, la trombosis de vena esplénica es una de las principales. Caracterizada por presentarse en endoscopia como várices gástricas fúndicas o aisladas sin compromiso esofágico, se manifiestan clínicamente como sangrado variceal agudo en un porcentaje variable de casos. Por tener etiopatogenia distinta a las várices por hipertensión portal, la respuesta frente a las medidas terapéuticas iniciales es distinta, el tratamiento endoscópico de elección es el uso de adhesivos tipo cianoacrilato, y en casos seleccionados, el enfrentamiento quirúrgico puede ofrecer una solución definitiva. Presentamos el caso de una paciente sin antecedentes de daño hepático crónico, que se presentó con hemorragia digestiva alta por sangrado de várices gástricas, con manejo inicial en unidad de paciente crítico y hemostasia por vía endoscópica. En estudio complementario se objetivó trombosis de la vena esplénica con esplenomegalia y múltiples formaciones varicosas en fondo y cuerpo gástrico. Posterior a estabilización se realizó esplenectomía como manejo definitivo, logrando regresión de várices gástricas en endoscopia de control...


Sujets)
Humains , Femelle , Adulte d'âge moyen , Hémorragie gastro-intestinale/étiologie , Thrombose veineuse/chirurgie , Thrombose veineuse/complications , Veine liénale/chirurgie , Gastroscopie , Hémostase , Splénectomie , Varices oesophagiennes et gastriques/complications , Veine liénale/anatomopathologie
11.
Annals of Surgical Treatment and Research ; : 208-214, 2015.
Article Dans Anglais | WPRIM | ID: wpr-62417

Résumé

PURPOSE: Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery. METHODS: We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups. RESULTS: APSVT was diagnosed a mean of 8.6 +/- 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296). CONCLUSION: Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.


Sujets)
Humains , Anticoagulants , Études cas-témoins , Études de suivi , Hémorragie , Mésentère , Analyse multifactorielle , Veine porte , Études rétrospectives , Veine liénale , Thrombose , Veines
12.
Singapore medical journal ; : e14-6, 2015.
Article Dans Anglais | WPRIM | ID: wpr-337191

Résumé

We herein report the use of endoscopic n-butyl-2-cyanoacrylate injections to obliterate a gastric varix, which led to cyanoacrylate embolisation in the splenic and portal veins in a single patient. Cyanoacrylate embolisation is a known but uncommonly reported complication of endoscopic sclerotherapy. This case report illustrates the successful management of this complication (i.e. cyanoacrylate embolisation in the splenic and portal veins) with anticoagulation and analyses the presentation and management of other cases of cyanoacrylate embolisation reported in the literature.


Sujets)
Sujet âgé , Humains , Mâle , Anticoagulants , Chimie , Utilisations thérapeutiques , Pression sanguine , Cyanoacrylates , Chimie , Embolie , Imagerie diagnostique , Thérapeutique , Varices oesophagiennes et gastriques , Traitement médicamenteux , Injections , Veine porte , Anatomopathologie , Sclérothérapie , Veine liénale , Anatomopathologie , Tomodensitométrie , Échographie-doppler
13.
Journal of Biomedical Engineering ; (6): 43-47, 2015.
Article Dans Chinois | WPRIM | ID: wpr-266729

Résumé

This paper aims to analyze the impact of splenic vein thrombosis (SVT) on the hemodynamic parameters in hepatic portal vein system. Based on computed tomography (CT) images of a patient with portal hypertension and commercial software MIMICS, the patient's portal venous system model was reconstructed. Color Doppler ultrasound method was used to measure the blood flow velocity in portal vein system and then the blood flow velocities were used as the inlet boundary conditions of simulation. By using the computational fluid dynamics (CFD) method, we simulated the changes of hemodynamic parameters in portal venous system with and without splenic vein thrombosis and analyzed the influence of physiological processes. The simulation results reproduced the blood flow process in portal venous system and the results showed that the splenic vein thrombosis caused serious impacts on hemodynamics. When blood flowed through the thrombosis, blood pressure reduced, flow velocity and wall shear stress increased. Flow resistance increased, blood flow velocity slowed down, the pressure gradient and wall shear stress distribution were more uniform in portal vein. The blood supply to liver decreased. Splenic vein thrombosis led to the possibility of forming new thrombosis in portal vein and surroundings.


Sujets)
Humains , Vitesse du flux sanguin , Pression sanguine , Simulation numérique , Hémodynamique , Hypertension portale , Cirrhose du foie , Veine porte , Veine liénale , Anatomopathologie , Thrombose , Anatomopathologie , Tomodensitométrie
14.
Korean Journal of Medicine ; : 20-25, 2014.
Article Dans Coréen | WPRIM | ID: wpr-86803

Résumé

Venous thrombosis in atypical locations means thrombosis of upper extremity deep vein, cerebral venous sinus, splanchnic vein including portal, hepatic, mesenteric and splenic vein, renal vein, ovarian vein and retinal vein. This thrombosis rarely occurred and could be affected by the involved organ when compared to the incidence and cause of deep vein thrombosis in lower extremity with or without pulmonary embolism. There is a limitation to perform a large-scaled randomized trial for these rare conditions, and several recommendations based on results of small-sized studies and observational registries are available now. Therefore, we need multi-department and international collaboration to test the efficacy and safety of anticoagulation including new oral anticoagulants in the treatment of venous thrombosis in atypical locations.


Sujets)
Anticoagulants , Syndrome de Budd-Chiari , Veines de l'encéphale , Comportement coopératif , Incidence , Membre inférieur , Embolie pulmonaire , Enregistrements , Veines rénales , Veine centrale de la rétine , Veine liénale , Thrombose , Membre supérieur , Thrombose veineuse profonde du membre supérieur , Veines , Thrombose veineuse
15.
Vascular Specialist International ; : 155-158, 2014.
Article Dans Anglais | WPRIM | ID: wpr-159758

Résumé

Portal vein (PV) thrombosis (PVT) is a rare condition with development of thrombosis in the PV and its branches. Further extension to the splenic and superior mesenteric vein (SMV) causes intestinal infarction, with a reported mortality of up to 50%. A variety of treatments for PVT exist including anticoagulation, thrombolysis, surgical thrombectomy, insertion of shunts, bypass surgery, and liver transplantation. We experienced a case of successfully treated by surgical thrombectomy with direct thrombolysis into the thrombosed-PV and SMV. A 31-year-old male presented worsening abdominal pain for one week. Preoperative contrast enhanced computed tomography scan revealed complete PVT extending to splenic vein and SMV. The PV was accessed surgically and opened by thrombectomy; visual inspection confirmed proximal and distal flow. Urokinase was administered directly into the inferior mesenteric vein with successful decrease in thrombus burden. The complete angiography showed complete dissolution of thrombosis in PV and SMV.


Sujets)
Adulte , Humains , Mâle , Abdomen aigu , Douleur abdominale , Angiographie , Infarctus , Transplantation hépatique , Veines mésentériques , Mortalité , Veine porte , Veine liénale , Thrombectomie , Thrombose , Activateur du plasminogène de type urokinase , Thrombose veineuse
16.
The Korean Journal of Gastroenterology ; : 110-114, 2014.
Article Dans Coréen | WPRIM | ID: wpr-22044

Résumé

Protein S (PS), a vitamin K-dependent glycoprotein, performs an important role in the anticoagulation cascade as a cofactor of protein C. Because of the presence of a pseudogene and two different forms of PS in the plasma, protein S deficiency (PSD) is one of the most difficult thrombophilias to study and a rare blood disorder associated with an increased risk of thrombosis. We describe a unusual case of previously healthy 37-year-old man diagnosed with portal-splenic-mesenteric vein thrombosis secondary to PSD. The patient was admitted to the hospital due to continuous nonspecific abdominal pain and nausea. Abdominal computed tomography revealed acute venous thrombosis from inferior mesenteric vein to left portal vein via splenic vein, and laboratory test revealed decreased PS antigen level and PS functional activity. Conventional polymerase chain reaction and direct DNA sequencing analysis of the PROS1 gene demonstrated duplication of the 166th base in exon 2 resulting in frame-shift mutation (p.Arg56Lysfs*10) which is the first description of the new PROS1 gene mutation to our knowledge. Results from other studies suggest that the inherited PSD due to a PROS1 gene mutation may cause venous thrombosis in a healthy young man without any known predisposing factor.


Sujets)
Adulte , Humains , Mâle , Anticoagulants/usage thérapeutique , Séquence nucléotidique , Protéines du sang/génétique , Codon stop , Exons , Veines mésentériques/imagerie diagnostique , Polymorphisme de restriction , Veine porte/imagerie diagnostique , Déficit en protéine S/complications , Analyse de séquence d'ADN , Veine liénale/imagerie diagnostique , Tomodensitométrie , Thrombose veineuse/diagnostic
17.
Keimyung Medical Journal ; : 164-168, 2014.
Article Dans Coréen | WPRIM | ID: wpr-24558

Résumé

Acute gastric variceal bleeding is one of the most serious complications in portal hypertension, and is associated with high mortality and morbidity. Endoscopic variceal obturation (EVO) using Histoacryl(R) (n-butyl-2-cyanoacrylate) has been accepted as an effective hemostatic procedure in acute gastric variceal bleeding. However, EVO is not a widely performed because of technical difficulties and complications such as mucosal ulceration, perforation, and systemic embolism. Herein, we report a patient who developed hepatic failure caused by portal vein occlusion by Histoacryl(R) injection for management of gastric variceal bleeding.


Sujets)
Humains , Embolie , Varices oesophagiennes et gastriques , Hypertension portale , Défaillance hépatique , Mortalité , Veine porte , Veine liénale , Ulcère
18.
Journal of Lipid and Atherosclerosis ; : 111-115, 2014.
Article Dans Anglais | WPRIM | ID: wpr-60462

Résumé

Left-sided portal hypertension and consequent gastric varices can occur in patients with isolated splenic vein thrombosis. It is a rare but clinically significant and curable cause of gastrointestinal hemorrhage. Our patient, a 20-year-old woman, with left flank pain was diagnosed with having idiopathic splenic vein thrombosis with resultant splenic infarction. Thorough workups for the possible etiologies of splenic vein thrombosis were all negative. After six months of anticoagulation, follow-up computed tomography revealed formation of gastric varices; one month following the discovery, she developed gastrointestinal bleeding. Splenectomy was performed, resulting in the resolution of gastric varices.


Sujets)
Femelle , Humains , Jeune adulte , Varices oesophagiennes et gastriques , Douleur du flanc , Études de suivi , Hémorragie gastro-intestinale , Hémorragie , Hypertension portale , Splénectomie , Infarctus splénique , Veine liénale , Thrombose
19.
The Ewha Medical Journal ; : 116-120, 2014.
Article Dans Coréen | WPRIM | ID: wpr-50906

Résumé

Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.


Sujets)
Adulte , Humains , Anticoagulants , Varices oesophagiennes et gastriques , Héparine bas poids moléculaire , Hypertension portale , Ischémie , Transplantation hépatique , Veines mésentériques , Pancréatite , Veine liénale , Thrombose , Veines , Thrombose veineuse
20.
Kidney Research and Clinical Practice ; : 161-164, 2014.
Article Dans Anglais | WPRIM | ID: wpr-194868

Résumé

Thromboembolism is a major complication of nephrotic syndrome. Renal vein thrombosis and deep vein thrombosis are relatively common, especially in membranous nephropathy. However, the incidence of portal vein and superior mesenteric vein (SMV) thrombosis in patients with nephrotic syndrome is very rare. To date, several cases of portal vein thrombosis treated by anticoagulation therapy, not by thrombolytic therapy, have been reported as a complication of nephrotic syndrome. Here, we report a case of portal, splenic, and SMV thrombosis in a patient with a relapsed steroid dependent minimal change disease who was treated successfully with anticoagulation and thrombolytic therapy using urokinase. Radiologic findings and his clinical conditions gradually improved. Six months later, a complete remission of the nephrotic syndrome was observed and the follow-up computed tomography scan showed the disappearance of all portal vein, splenic vein, and SMV thrombi.


Sujets)
Humains , Études de suivi , Glomérulonéphrite extra-membraneuse , Incidence , Veines mésentériques , Néphrose lipoïdique , Syndrome néphrotique , Veine porte , Veines rénales , Veine liénale , Thromboembolie , Traitement thrombolytique , Thrombose , Activateur du plasminogène de type urokinase , Thrombose veineuse
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