Caracterización de las complicaciones infecciosas en pacientes con cirrosis hepática internados en un hospital universitario / Characterization of infectious complications in patients with liver cirrhosis admitted to a university hospital

La cirrosis hepática ocasiona significativa mortalidad y morbilidad. El objetivo de esta investigación fue conocer las complicaciones infecciosas de los pacientes con cirrosis hepática internados en un hospital universitario de San Lorenzo, Paraguay. Se analizaron las historias clínicas de los pacientes con diagnóstico de cirrosis hepática y una enfermedad infecciosa internados en el Hospital de Clínicas, desde enero del año 2015 a enero del marzo 2020. La información se analizó utilizando EpiInfo. Se incluyeron 106 pacientes con una edad promedio de 59,3 ± 18 años. La enfermedad infecciosa más frecuente fue la neumonía con un 35 % y la causa más frecuente de cirrosis fue el alcoholismo, se observó además una frecuencia de 39% de bacteriemia con predominio etiológico de bacterias gram negativas. Hubo un promedio de 19,7 días de estancia hospitalaria. En conclusión, la enfermedad más frecuente fue la neumonía y las bacterias aisladas con mayor frecuencia fueron Klebsiella pneumoniae y Escherichia coli

Liver cirrhosis causes significant mortality and morbidity. The objective of this research was to know the infectious complications of patients with liver cirrhosis admitted to a university hospital in San Lorenzo, Paraguay. The medical records of patients diagnosed with liver cirrhosis and an infectious disease admitted to the Hospital de Clínicas were analyzed from January 2015 to January 2020. The information was analyzed using Epi Info. One hundred six patients with an age average of 59.3 ± 18 years were included. The most frequent infectious disease was pneumonia (35%) and the most frequent cause of cirrhosis was alcoholism, a frequency of 39% of bacteremia with an etiological predominance of gram-negative bacteria was also observed. There was an average of 19.7 days of hospital stay. In conclusion, the most common disease was pneumonia and the most frequently isolated bacteria were Klebsiella pneumoniae y Escherichia coli

Prevalencia y severidad del síndrome hepatopulmonar en pacientes con cirrosis hepática del Hospital Nacional Cayetano Heredia, entre enero y diciembre del 2015 / Prevalence and severity of the hepatopulmonar syndrome in patients with liver cirrhosis attended at Cayetano Heredia Hospital, between January and December 2015

Introducción: El sindrome hepatopulmonar (SHP) es una complicación poco frecuente de la cirrosis hepática (CH) que disminuye considerablemente la calidad de vida de las personas que la padecen. Objetivos: Determinar la prevalencia y severidad del SHP en los pacientes con CH atendidos en el Hospital Nacional Cayetano Heredia (HCH) en el periodo comprendido entre enero a diciembre del 2015. Material y métodos: Estudio transversal, con tamaño de muestra necesario para determinar la prevalencia puntual calculado en 297 pacientes. Resultados: La prevalencia del SHP fue de 0,7% y los casos identificados se clasificaron como SHP leve y severo. Conclusión: La prevalencia del SHP es muy baja en la población de pacientes con cirrosis hepática atendidos en el Hospital Nacional Cayetano Heredia

Introduction: The hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis (LC) which significantly diminishes the quality of life for people who suffer. Objectives: To determine the prevalence and severity of HPS in patients with CH treated at the Cayetano Heredia (HCH) Hospital in the period from January to December 2015. Materials and methods: Cross-sectional study with sample size needed to determine the point prevalence calculated in 297 patients. Results: The prevalence of HPS in 0.7% and the identified cases were classified as mild and severe SHP. Conclusion: The prevalence of HPS is very low in the population of patients with liver cirrhosis treated at the Cayetano Heredia Hospital

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

Peritonitis bacteriana espontánea por Listeria monocytogenes en un paciente con cirrosis hepática: reporte de un caso / Spontaneous bacterial peritonitis due to Listeria monocytogenes in a patient with cirrhosis: case report

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients. Listeria monocytogenes is a rare cause of SBP, which should be suspected in individuals with impaired immunity such as advanced liver disease and inadequate response to standard antibiotic therapy. We report a case of a 72 year-old patient with liver cirrhosis secondary to alcohol consumption, asymptomatic carrier of Hepatitis B virus, diabetes Type II and coronary artery disease; who is admitted with a diagnosis of hepatic encephalopathy and suspicion of spontaneous bacterial peritonitis receiving empiric antibiotic treatment with ceftriaxona. Initially he showed clinical response but a few days later he got worse. Ascitic culture confirmed infection by Listeria monocytogenes. Antibiotic treatment was adjusted but patient continued deteriorating progressively, and finally died due to renal dysfunction.

La peritonitis bacteriana espontánea (PBE) es una complicación frecuente y grave en los pacientes cirróticos. Listeria monocytogenes es una causa poco frecuente de PBE, que debe sospecharse en individuos con inmunidad alterada como es la enfermedad hepática avanzada y con respuesta inadecuada a terapia antibiótica habitual. Presentamos el caso de un paciente de 72 años con antecedentes de cirrosis hepática secundaria a consumo de alcohol, portador asintomático del virus de la Hepatitis B (VHB), diabético tipo II y cardiópata coronario. Se hospitaliza por encefalopatía hepática secundaria a PBE, recibe tratamiento antibiótico empírico con ceftriaxona con respuesta clínica inicial y deterioro posterior. Cultivo de líquido ascítico confirma infección por Listeria monocytogenes. Pese a ajuste de tratamiento antibiótico, continúa empeorando y finalmente fallece por disfunción renal.

Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients

BACKGROUND/AIMS: Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. METHODS: We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. RESULTS: Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. CONCLUSIONS: The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade.

In-hospital mortality risk factors in patients with ascites due to cirrhosis / Fatores de risco de mortalidade intra-hospitalar em pacientes com ascite por cirrose hepática

Introduction: ascites is one of the most common complications of cirrhosis associated with a high rate of mortality. Although several scores have been developed in order to assess the prognosis of the disease, they were designed for predicting liver transplantation requirements and mortality in the short term, but not while in hospital. The aim of this study was to weigh risk factors for in-hospital mortality in adult patients with ascites due to alcoholic cirrhosis. Material and methods: we performed a cross-sectional study in 180 adult patients with diagnosis of cirrhosis with portal hypertension associated with high alcohol intake. The diagnosis of cirrhosis was made by liver echography and portal hypertension was defined by clinical features plus serum-ascites albumin gradient. Sampled individuals were subjected to complete clinical examination. Child Pugh and the MELD scores were applied in all the patients. Results: nineteen patients died while in-hospital. Mortality was associated with increased levels of serum white blood cell, urea, creatinine, prolonged prothrombin time, aspartate aminotransferase and alanine aminotransferase. We conducted a multiple binary logistic to predict in-hospital mortality which yielded that serum urea, creatinine and prothrombin time made a significant contribution to prediction with an OR 14 (95% CI 12.8 - 16.7 p = 0.03), 2 (95% CI 0.5 - 3.47, p = 0.04), and 2 (95% CI 1.03 - 2.31, p = 0.01) linearly-related. Conclusions: our results suggest that acute renal failure and prolonged prothrombin time are predictors of in-hospital mortality in patients with portal hypertension due to alcoholic cirrhosis. .

Introdução: ascite é uma das complicações mais comuns de cirrose associadas a uma elevada taxa de mortalidade. Embora vários escores tenham sido desenvolvidos a fim de avaliar o prognóstico da doença, eles foram concebidos para prever requisitos de transplante de fígado e mortalidade a curto prazo, mas não durante a internação. O objetivo deste estudo foi o de pesar fatores de risco para a mortalidade intra-hospitalar em pacientes adultos com ascite decorrente de cirrose alcoólica. Material e métodos: foi realizado um estudo transversal em 180 pacientes adultos com diagnóstico de cirrose com hipertensão portal, associada à alta ingestão de álcool. O diagnóstico de cirrose foi feita por ecografia hepática e a hipertensão portal foi determinada por características clínicas e pelo gradiente de albumina soro-ascite. Indivíduos avaliados foram submetidos a exame clínico completo. A classificação de Child-Pugh e a escala MELD foram aplicadas em todos os pacientes. Resultados: dezenove pacientes morreram durante a internação. A mortalidade foi associada ao aumento dos níveis de glóbulos brancos, ureia, creatinina, aspartato aminotransferase, alanina aminotransferase e tempo de protrombina prolongado. Realizamos uma logística binária múltipla para prever a mortalidade intra-hospitalar, que confirmou que ureia, creatinina e tempo de protrombina contribuíram significativamente para a previsão, com uma OR = 14 (IC 95% 12,8-16,7 p = 0,03), 2 (IC 95% 0,5-3,47, p = 0,04), e 2 (IC 95% 1,03-2,31, p = 0,01), relacionada linearmente. Conclusões: nossos resultados sugerem que a insuficiência renal aguda e de tempo de protrombina prolongado são preditores de mortalidade intra-hospitalar em pacientes com hipertensão portal decorrente de cirrose alcoólica. .

Mortalidade no pós-operatório tardio da derivação gástrica em pacientes do Sistema Único de Saúde: elevada frequência de cirrose alcoólica e suicídios / Long-term mortality of patients submitted to Roux-en-Y gastric bypass in Public Health System: high prevalence of alcoholic cirrhosis and suicides

RACIONAL: A cirurgia bariátrica é uma opção terapêutica valiosa para tratamento de casos graves de obesidade. Sua utilização em larga escala motivou a realização de diversas pesquisas que comprovaram a eficiência do procedimento na redução do peso corporal, melhora das comorbidades e redução da mortalidade em curto e médio prazo. Entretanto, são necessários mais estudos a respeito da mortalidade de médio e longo prazo e suas causas, principalmente na população brasileira. OBJETIVO: Avaliar a mortalidade após período mínimo de um ano da operação bariátrica discriminando as causas de óbito e sua relação com características pré-operatórias. MÉTODOS: Foram analisados os dados de 248 pacientes do Sistema Único de Saúde, com seguimento entre um e 12 anos, submetidos à derivação gástrica em Y-de-Roux. As variáveis analisadas foram: sexo, idade na operação, índice de massa corporal pré-operatório, presença de comorbidades e tabagismo. As informações sobre mortalidade foram obtidas através do Sistema de Informações sobre Mortalidade. Os óbitos foram categorizados segundo o Código Internacional de Doenças 10 e a análise estatística feita através do programa STATA TM 9.2. RESULTADOS: Ocorreram nove óbitos tardios, sendo cinco de mulheres. A média de idade dos pacientes que faleceram foi 48,3±8,4 anos e o índice de massa corporal pré-operatório foi 56,0±7,4 kg/m². As causas de óbito foram cirrose alcoólica (n=2), suicídios (n=2), causas infecciosas (n=2), insuficiência respiratória (n=1), agranulocitose (n=1) e causa desconhecida (n=1). Nenhum óbito teve relação direta com o procedimento cirúrgico e não houve influência das características pré-operatórias avaliadas na mortalidade. CONCLUSÃO: Não houve relação entre a mortalidade e as características pré-operatórias. A alta frequência de mortalidade por suicídio e por complicações do alcoolismo indica a necessidade de seguimento clínico mais rigoroso, envolvendo adequado apoio psicológico aos pacientes.

BACKGROUND: Bariatric surgery is a valuable therapeutic option to severe obesity. Many researches have assessed the procedure efficiency on weight reduction, improvement in comorbidities and reduction of mortality. However, studies of late mortality and its causes are still necessary, mainly in the Brazilian population. AIM: To assess late mortality, discriminating causes of death and its association with pre-operative characteristics in a series of patients submitted to bariatric surgery. METHODS: Data analyses of 248 patients submitted to Roux-en-Y gastric bypass through Public Health System, from one up to 12 years of follow-up. The analyzed variables were: gender, age by the time of the surgery, pre-operative body mass index, comorbidities and smoking. The information about mortality was obtained through the Mortality Information System. The deaths were categorized according to International Classification of Diseases 10 and statistics analysis was done through the software STATA TM 9.2. RESULTS: There were nine deaths, five of them were female. The mean age of the patients who died was 48.3±8.4 years and the pre-operative body mass index was 56.0±7.4 kg/m². The causes of death were: alcoholic cirrhosis (n=2), suicide (n=2), infectious causes (n=2), respiratory insufficiency (n=1), agranulocytosis (n=1) and unknown causes (n=1). None of the deaths was directly related to the surgery and there was no association of the pre-operative characteristics in mortality. CONCLUSION: There was not any association between late mortality and pre-operative characteristics. The high frequency of suicide and alcoholic cirrhosis mortality indicates the strict follow-up concerns, with appropriate psychological support to the patients.

Acute Hepatic Encephalopathy Presenting as Cortical Laminar Necrosis: Case Report

We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.

Occult Hepatitis B Virus Infection and Hepatocellular Carcinoma / 대한소화기학회지

Many studies have suggested that occult HBV infection has a substantial clinical relevance to hepatocellular carcinoma (HCC). Occult HBV infection is an important risk factor for the development of cirrhosis and HCC in patients without HBsAg. As a matter of fact, occult HBV infection is one of the most common causes of crytogenic HCC in endemic areas of HBV. However, there still are controversial issues about the association between occult HBV infection and HCC according to the underlying liver disease. In alcoholic cirrhosis, occult HBV infection may exert synergistic effect on the development of HCC. However, there is insufficient evidence to relate occult HBV infection to hepatocarcinogenesis in non-alcoholic fatty liver disease. In cryptogenic HCC, occult HBV infection may play a direct role in the development of HCC. In order to elucidate the assocciation between occult HBV infection and HCC, underlying liver disease must be specified and larger number of cases must be included in future studies.

A Case of Diaphragmatic Hernia Induced by Radiofrequency Ablation for Hepatocellular Carcinoma / 대한소화기학회지

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.

Hidrotórax hepático: cuando la evolución es la evidencia / Hepatic hydrothorax: when the patient's course is the evidence you need

Se analiza el caso clínico de un paciente de 61 años, alcoholista, con hidrotórax unilateral derecho y signos clínicos de insuficiencia hepatocítica crónica planteándose como etiología del derrame el hidrotórax hepático. A propósito de este caso clínico se discuten los criterios diagnósticos de esta entidad, forma de estudio, patrones evolutivos, complicaciones y la eficacia de las distintas opciones terapéuticas

Hepatocarcinoma y trombosis portal diagnosticados por ecografía y tomografía computada en pacientes cirróticos chilenos en un hospital público, 2004 - 2011 / Hepatocellular carcinoma and portal vein thrombosis diagnosed by sonography and ct scan in chilean cirrhotic patients between 2004 and 2011

There is no available data on prevalence of hepatocellular carcinoma (HCC) and portal thrombosis (PT) in Chilean cirrhotic patients. Objectives: To evaluate the development of these entities and the role ultrasound (US) may play as the imaging method of choice in their diagnostic approach. Material and methods: A cohort study of patients with diagnosis of cirrhosis by US or CT scans between 2004 and 2008. We evaluated both demographic and clinical records, along with disease development until 2011, by performing a retrospective review of their imaging findings. We investigated whether patients presented HCC and / or PT as detected by US / CT studies. Results: Two hundred and eleven (211) patients with an average age of 62.6 years were included. HCC was diagnosed in 10.4 percent of cases, whilst PT was observed in 4.3 percent of patients. A 33 percent of PT occurred in association with HCC and exhibited worse survival rates. Ultrasonographic studies yielded suspicious results in a significant percentage of cases, thus CT scans were performed to confirm the diagnosis. Conclusions: Ultrasound examination appears to be a useful tool for detecting complications of cirrhosis.

No existen datos en pacientes cirróticos chilenos de prevalencia de hepatocarcinoma(CHC) y trombosis portal(TP). Objetivos: Evaluar el desarrollo de estas complicaciones y el rol que podría jugar el ultrasonido (US) como primer método de imagen en su aproximación diagnóstica. Material y métodos: Estudio de cohorte en pacientes diagnosticados mediante US o TC de cirrosis entre 2004 y 2008. Se evaluaron datos demográficos, clínicos, y su evolución hasta 2011, realizando revisión retrospectiva de sus estudios imagenológicos. Se investigó si presentaron HCC y/o TP que fueran detectados mediante US/TC. Resultados: Se incluyeron 211 pacientes, con un promedio de 62,6 años. En el 10,4 por ciento se diagnosticó HCC y en el 4,3 por ciento TP. El 33 por ciento de TP ocurrieron asociadas a CHC y determinaron peor sobrevida. El US fue sospechoso en un porcentaje significativo de los casos, motivando la realización de TC confirmatoria. Conclusiones: El US aparece como una herramienta útil para la detección de complicaciones de cirrosis.

Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization

A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment, the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes.

A Case of Hepatic Peribiliary Cysts in a Patient with Alcoholic Liver Cirrhosis / 대한소화기학회지

Hepatic peribiliary cysts (HPCs) are characterized by cystic dilatations of the peribiliary glands located throughout the branches of the biliary systems. Specifically, they are mainly located along the hepatic hilum and major portal tracts. The natural history and prognosis of HPCs are uncertain. In fact, almost all HPCs have been discovered incidentally during radiological examination or autopsy, and they are considered to be clinically harmless. Recently, several cases of HPCs associated with obstructive jaundice or liver failure were reported in patients with pre-existing liver disease in several studies. However, until now there have been no reports of such a case in Korea. Herein, we report a case of HPCs that show a disease course with a poor prognosis. These HPCs developed in a 47-year-old man with progressive alcoholic liver cirrhosis.

Esophageal Sinus Formation due to Cyanoacrylate Injection for Esophageal Variceal Ligation-induced Ulcer Bleeding in a Cirrhotic Patient / 대한소화기학회지

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.

Invasive Aspergillosis Arising from Ureteral Aspergilloma

Ureteral obstruction may develop in immunocompromised patients with an Aspergillus fungal infection. Infections can progress to invasive aspergillosis, which is highly lethal. We report a case of a 56-year-old man with alcoholic cirrhosis of the liver and diabetes. He had ureteral aspergilloma, discovered as a saprophytic whitish mass. It was treated by ureteroscopic removal, however, he refused antifungal treatment. His condition progressed to invasive aspergillosis, and died from sepsis and hepatorenal syndrome.

Spontaneous bacterial peritonitis caused by Streptococcus bovis: case report and review of the literature

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication that occurs in patient with cirrhosis and ascites. It occurs in 10 percent to 30 percent of patients admitted to hospital. The organisms that cause SBP are predominantly enteric. Escherichia coli is the most frequent recovered pathogen, and Gram-positive bacteria, mainly Staphylococcus spp., are being considered an emerging causative agent of SBP. Streptococcus bovis that may be found as part of the commensal bowel flora in about 10 percent of healthy adults constitute an uncommon cause of peritonitis that was first reported in 1994. We describe the first case of SBP at the University Hospital of Santa Maria (HUSM) caused by S. bovis, resistant to the antibiotics erythromycin and clindamycin (inducible clindamycin resistance detected by disk diffusion test using the D-zone test).

A case of primary hepatic epithelioid hemangioendothelioma with spontaneous rupture / 대한간학회지

Primary hepatic epithelioid hemangioendothelioma is a rare neoplasm of endothelial origin. The clinical manifestations are nonspecific, ranging from complete absence of symptoms to hepatic failure and death. Spontaneous rupture of a hepatic epithelioid hemangioendothelioma is an extremely rare presentation. We present a case of primary hepatic epithelioid hemangioendothelioma in a 65-year-old male patient with alcoholic liver cirrhosis. He was hospitalized due to epigastric pain and multiple liver masses on abdominal ultrasound. Dynamic liver CT imaging revealed multiple peripheral nodular enhanced mass lesions with delayed centripetal enhancement, and the adjacent collection of high-attenuation fluid along the liver capsule. Abdominal tapping revealed blood in the peritoneal cavity. Primary hepatic epithelioid hemangioendothelioma with spontaneous rupture was finally diagnosed based on a histopathologic examination revealing positive immunohistochemical staining for CD34.