Trombosis de la vena porta: a propósito de 4 casos en el Hospital Militar “Dr. Carlos Arvelo” / Portal vein thrombosis: with regard to 4 cases in Hospital Militar

La trombosis venosa portal es una oclusión de la misma por un coágulo y/o trombo; o por otras causas como cirrosis, cáncer de hígado, páncreas o estómago. Afecta únicamente al tronco portal. En ausencia de un tumor maligno que invada o comprima el eje esplenoportal, la trombosis es el mecanismo etiopatogénico más frecuente que ocasiona la obstrucción venosa. Según las series estudiadas en un 7%-22% de los pacientes con trombosis portal no se identifica una condición protrombótica (trombosis portal idiopática). No obstante, en el resto de ocasiones en un 40% de casos existe un factor local desencadenante y en un 60% de casos restantes factores trombogénicos sistémicos. En más de un 15 % de estos pacientes coexisten factores etiológicos múltiples. Las consecuencias clínicas de la trombosis venosa del eje esplenoportal dependen del momento evolutivo en el que se encuentre ésta, pero también de la extensión del trombo. La principal manifestación suele ser el dolor abdominal, con frecuencia irradiado a espalda. Pueden aparecer síntomas inespecíficos como fiebre sin foco conocido, síntomas dispépticos (náuseas y plenitud postprandial) y malestar general. Los parámetros de función hepática, albúmina y tiempo de protrombina muestran mínimas alteraciones. En este trabajo quisimos exponer 4 casos de pacientes de nuestro centro a los cuales se les realizó el diagnóstico de trombosis de la vena porta, con edades comprendidas entre 30-60 años, con predominio del sexo masculino, y quienes han cumplido regularmente su tratamiento no presentando complicaciones durante su evolución, manteniéndose estables en su control entre 2003 y 2009...

Portal vein thrombosis is its occlusion by a clot and/or thrombus, or by other causes such as cirrhosis, cancer of liver, pancreas or stomach. It affects the portal trunk only. Whenever a malignant tumor invading or compressing the splenoportal axis is not present, thrombosis is the most frequent ethiopathogenetic mechanism causing vein obstruction. According to the studied series, in 7-22% of patients with portal thrombosis no prothrombotic condition (idiopathic portal thrombosis) is identified. However, in 40% of the remaining cases there is a local triggering factor, and the other 60% shows systemic thrombogenetic factors. Multiple etiologic factors coexist in over 15% of said patients. The clinical consequences of the splenoportal axis vein thrombosis depend on the evolution momentum where the thrombosis is found, and also on the thrombus’ dimension. Abdominal pain could be the main manifestation, frequently irradiated to the back. Non-specific symptoms could appear, such as fever of unknown origin, dyspeptic symptoms (nausea and postprandial fullness), and general malaise. The parameters of hepatic function, albumin, and of prothrombin time show minimal changes. In this study the cases of 4 patients of this health center were exposed; said patients were diagnosed with portal vein thrombosis and were of ages ranging 30-60, male-sex prevalence, who regularly followed their treatment and did not present complication in their evolution, staying stable in their 2003 and 2009 control...

A Case of Acute Esophageal Necrosis with Gastric Outlet Obstruction / 대한소화기학회지

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.

Double gastric outlet obstruction with epidermolysis bullosa in a neonate.

We report a 2-day-old baby who had double gastric outlet obstruction, rectovaginal fistula and associated epidermolysis bullosa. She recovered after excision of diaphragms, pyloroplasty and pelvic colostomy.

Phytobezoar as a late complication of vertical banded gastroplasty

In the last two decades, bariatric surgery has become a popular mean for treating morbid obesity. Although the newer procedures are claimed to have less complications than the older ones, the world is still at a learning curve. Numerous complications of this surgery are known and require recognition to be appropriately treated. Phytobezoar is one of the rare late complications following Bariatric surgery and various factors can contribute to its development including hypochlorhydria, diminished antral motility, and incomplete mastication. The case being presented is a rare case of gastric outlet obstruction due to phytobezoar almost two years following vertical banded gastroplasty. The patient was successfully treated with Sodium Docusate, which is a faecal softener and weak stimulant laxative. To our knowledge, this is the first case report presenting such a complication following vertical banded gastroplasty. Phytobezoar should be considered in the differential diagnosis of epigastric symptoms in patients with a history of gastric surgery. Sodium docusate was an effective medical therapy in this patient

Parahiatal hernia with gastric obstruction in a child.

Parahiatal hernia refers to herniation of abdominal viscera into the chest adjacent to an intact hiatus. Spontaneously occurring parahiatal herniae are extremely rare. We report a 4-year-old boy who presented with intermittent vomiting and had such a hernia, where the herniated stomach had undergone partial volvulus. He was symptom-free after surgical repair.

Gastric outlet obstruction as a late complication of ingestion of diazinon.

Acute gastrointestinal symptoms are known to occur with organophosphorus compounds poisoning. Delayed complication in the form of gastric outlet obstruction has not been reported to date. We report gastric outlet obstruction developing after diazinon ingestion in a young girl. She responded to endoscopic balloon dilatation.

Spontaneous neonatal gall bladder perforation.

A full term neonate was operated for diaphragmatic eventration through the chest. Postoperatively the baby developed gastric outlet obstruction. Ultrasonography and barium meal examination were suggestive of extrinsic compression in the region of the pylorus. At laparotomy a gall bladder perforation was found producing a biloma just abve the pylorus. Drainage of the bilioma and temporary cholecystostomy cured the gastric outlet obstruction.

Helicobacter pylori infection in duodenal ulcer with gastric outlet obstruction.

One hundred and three patients were included in the study. Thirty seven had duodenal ulcer (DU) (Group I), 35 DU with gastric outlet obstruction (GOO) with presence of an active ulcer in the duodenum (Group II). Thirty one had DU with GOO but no active ulcer (Group III). Presence of H. pylori infection was determined by urease test, serology and/or histology. The prevalence of H. pylori in these groups was compared. Levels of Anti-H. pylori IgG antibody titres were also compared. The patients with duodenal ulcer (DU) were significantly younger (38 +/- 2 years) compared to those with established gastric outlet obstruction without ulcer (45 +/- 2 years) (P = 0.02). The prevalence of H. pylori infection in DU (95%), DU with GOO with ulcer (91%) and DU with GOO but no ulcer (90%) was not significantly different (p > 0.05). Anti-H. pylori IgG antibody titre levels were 72 +/- 6 EU/ml in Group III. The titre levels between Group I and Group III were significantly different (P < 0.05). The prevalence of H. pylori infection is high is patients with DU and is unaltered by gastric outlet obstruction. The presence or absence of an active ulcer with gastric outlet obstruction does not affect its association with H. pylori infection.

Obstrucción del antro gástrico en enfermedad granulomatosa crónica: informe de un caso / Obstruction of the gastric antrum in chronic granulomatous disease: report of a case

Se describe el caso de una paciente de seis años con obstrucción del antro gástrico, 24 meses después de haberse diagnosticado como enfermedad granulomatosa crónica. Las principales manifestaciones fueron los vómitos y el dolor abdominal. El diagnóstico de obstrucción del antro gástrico se estableció con estudios de gabinete: Serie esofagogastroduodenal, tomografía axial computarizada, abdominal y endoscopia del tubo digestivo alto. Se destaca la excelente correlación entre los estudios de gabinete y la obstrucción del antro gástrico en pacientes con enfermedad granulomatosa crónica

Complicaciones de úlcera péptica: 1980-1986 / Complications of peptic ulcer: 1980-1986

Las complicaciones de úlcera péptica comprenden: 1.- La hemorragia digestiva alta, considerandose como tal aquella hemorragia que tiene su orígen en el tracto digestivo, por encima del ángulo de Treitz y que se manifiesta como "hematemesis", como "melena" (o ambas), o bien como una anemia crónica ferropriva, cuya etiología digestiva se puede demostrar; 2.- La obstrucció de la vía de salida del estómago o del duodeno que puede deberse a la cicatrización espasmo y tumefacción inflamatoria asociados a una úlcera activa, o bien, lo que es más común, a ambas cosas; 3.- La perforación libre o tabicada; 4.-La penetración. Se tomaron en cuenta 334 pacientes que fueron hospitalizados en el C.G.B.J entre 1980 a 1986, en quienes se llegó al diagnóstico de úlcera péptica y/o suscomplicaciones; de los 334 casos, 236 correspondieron a varones (70.7 por ciento) y 98 a mujeres (29.3 por ciento). El diagnóstico fue establecido por endoscopía alta, encontrandose 187 casos de úlcera duodenal (56 por ciento), úlcera gástrica en 101 casos (30.2 por ciento) y úlcera gástrica y duodenal en 46 casos (13.8 por ciento). 151 (45.2 por ciento) pacientes (107 varones y 44 mujeres) presentaron hemorragia digestiva alta. El sindrome de retención gástrica se encontró en 24 casos (7.18 por ciento) de los cuales se operaron 20 pacientes (15 varones y 5 mujeres). Siete pacientes fueron intervenidos de emergencia por perforación de úlcera péptica (4 varones y 3 mujeres); de estos 7 casos fallecieron dos pacientes por sepsis. Se realizaron 17 intervenciones quirurgicas por hemorragia digestiva (15 varones y 2 mujeres), número que corresponde al 11.25 por ciento de todos los casos de hemorragia digestiva alta. Cuatro casos fueron operados por úlcera péptica penetrada (3 varones y una mujer) que corresponden al 1.19 por ciento de las complicaciones de úlcera péptica. De igual manera fueron operados 2 casos por perforación contenida o tabicada de úlcera péptica (0.59). El total de complicaciones sumó 188 casos de los que 133 corresponden al sexo masculino (70.7 por ciento) y 55 casos corresponden a mujeres (29.3 por ciento); el total de complicaciones nos dan un (65.28 por ciento); cifra que se encuentra por encima de las mencionadas estadísticas médicas de paises vecinos (Csendes A.), pero si se considera en forma aislada los casos de hemorragia digestiva alta vemos que el porcentaje de complicaciones (45.2 por ciento), es exageradamente alto comparados con estadísticas de otros paises...