Enfermedad veno-oclusiva hepática, colitis ulcerosa idiopática y trombosis portal: comunicación de un caso clínico / Hepatic veno-occlusive disease, idiopathic ulcerative colitis and portal thrombosis. Report of one case

We report a previously healthy 29 years old man, presenting with a sudden episode of abdominal pain, mild jaundice, hepatomegaly and ascites. Magnetic resonance imaging study and liver biopsy were compatible with veno-occlusive disease. Incidentally, an ulcerative colitis and portal vein thrombosis were diagnosed. Anticoagulant treatment was started, with good clinical and radiological response. Veno-occlusive disease of the liver must be suspected In cases of liver failure and ascites associated to procoagulant conditions.

Greffe de moelle osseuse allogenique complications. 2 eme partie

Bone marrow transplantation increase the chances of cure of many hemetologie and allso neoplasmes cancers. The procedure is however a cause of expected mortality and morbidity. The complications are represented by mucocutaeous, toxicaty graft versus host disease, veno-occlusive desease and mort importanlly injections consequences all this complications needs to be prevented and treated considering the risk associated to the moderling immunosuppression

Acute on chronic phenomenon in hepatic IVC obstruction: a case report.

Hepatic IVC obstruction though common is usually misdiagnosed because of lack of appreciation of the disease. Patient with chronic disease may develop acute exacerbation, which may be precipitated by surgery or endoscopic procedures. It is a report of a case of chronic IVC disease with acute development of ascites following gallbladder surgery.

Hepatic venous outflow obstruction.

Hepatic venous outflow obstruction also called the Budd-Chiari syndrome is increasingly being recognized as a cause of portal hypertension. In western countries the obstruction is usually in the hepatic veins while in reports from South Africa, Japan and India the predominant cause is a block in the IVC at the level of the diaphragm above the entry of the hepatic veins. A hypercoagulable state caused by myeloproliferative haematological disorders, clonal defects in haemopoietic stem cells, lupus anticoagulant, contraceptive pills and postpartum state are some of the aetiological conditions described. However in 25% to 75% cases no cause can be identified. The predominant presenting features in patients with hepatic vein obstruction are hepatomegaly and ascites while those with IVC obstruction show prominent veins on the trunk and back. Ultrasound examination should be the first investigative step. However a liver biopsy is the gold standard of diagnosis. To confirm the site of obstruction inferior vena cavography or functional hepatography may be required. In the acute phase thrombolytic therapy may be useful but for established cases either surgical intervention in the form of shunts or recently balloon angioplasty may be helpful. For patients with established cirrhosis and end-stage liver failure the only alternative is liver transplantation. All these patients however should be put on long term anticoagulants to prevent rethrombosis. Some series have reported that upto 45% of patients may develop hepatocellular carcinoma on long term followup. With proper management a larger proportion of patients can be returned to a useful productive life.

Enfermedad veno-oclusiva por ingestion de "infusión" de plantas / Veno-occlusive dissease by herbal infussion ingestion

En el niño la ingestión de Alcaloides Pirrolizidinas producen una endoflebitis de las venas hepáticas con el consiguiente desarrollo de Enfermedad Veno-Oclusiva que simula un Síndrome de Budd Chiari. También la ingestión de Aceites volátiles que se encuentran en numerosas plantas son capaces, por su efecto tóxico de producir esta patología. Presentamos el caso de 2 niños de sexo masculino provenientes del medio rural y urbano de 16 y 19 meses de edad respectivamente que recibieron "infusión" de plantas: PAZOTE: Chenopodium ambrosoides y una mezcla de POLEO: Saturcia bronnei con TILO: Tilia Europea, con propósitos medicamentosos y posterior a ello, presentaron en forma aguda: aumento de volumen del abdomen, ascitis y hepatomegalia progresiva, con alaninoaminotransferasas elevadas, disminución de la actividad de tromboplastina y del tiempo de protrombina, con signos de hipertensión portal y edema generalizado. La biopsia hepática reportó en ambos casos extensas zonas hemorrágicas intraparenquimatosas con necrosis hepato celular masiva, fibrosis septal severa y focal y engrosamiento del endotelio de los vasos intrahepáticos. La evolución clínica de ambos fue a la CIRROSIS HEPATICA

A study of inferior vena cava obstruction.

Inferior Vena Cava obstruction as a major cause of hepatic venous outflow block is not so common. A prospective study of 20 cases gave us an opportunity to device a management protocol for this disorder. Out of 20 cases we had studied, 12 had only inferior Vena Cava obstruction while rest of the 8 cases had both hepatic vein and IVC blockade. However, balloon cavoplasty showed remarkable results with substantial clinical and haemodynamic improvement in cases with isolated IVC obstruction. Therefore, we suggest that patients with IVC obstruction should be actively managed with Vena-cavography followed by cavoplasty. Treatment of Hepatic venous obstruction along with IVC obstruction is controversial; bypass shunt is usually required and long term follow-up studies are required to establish safety and efficacy.

Enfermedad hepática veno-oclusiva asociada a la ingestión de humanrripa (senecio tephrosioides) / Hepatic veno-oclusive disease associated to ingetion of huamanrripa (senecio tephrosioides)

Se reporta un caso de enfermedad veno-oclusiva del hígado (EHVO) en una mujer de 38 años de edad que había consumido ocasionalmente "huamanrripa" (Senecio tephrosioides) durante algunos años como antitusígeno. Fue hospitalizada por presentar dolor abdominal difuso, ictericia y anasarca durante 10 semanas. El estudio histológico de la biopsia hepática mostró marcada congestión a predominio centrolobulillar, focos de necrosis y en algunas áreas, inversión de la arquitectura del lobulillo hepático. En los siguientes 13 meses ha sido hospitalizada en 4 ocasiones por complicaciones de hipertensión portal. Este es el primer caso reportado de enfermedad hepática veno-oclusiva asociada a la ingesta de S. tephrosioides. Es muy probable que esta planta usada en la medicina tradicional peruana contenga alcaloides pirrolizidina, sustancias hepato- y nefrotóxicas que estan presentes en otras especies del género Senecio. Debido a la popularidad actual de las medicinas alternativas se espera un aumento en la incidencia de EHVO