ABSTRACT
BACKGROUND: Calcification of abdominal lymph node is a common clinical phenomenon, but it is extremely rare to cause serious adverse clinical outcomes. In the present case, the ruptured hemorrhage of the oesophagogastric fundic varices occurred as a result of portal hypertension due to compression of the portal vein by calcified lymph nodes. The patient was treated with medication, interventional therapy, endoscopic therapy, and surgery, respectively and the four different treatment options for the bleeding are worth summarizing. The etiology of this case is extremely rare and is the first to be reported in the world. CASE PRESENTATION: A 32-year-old male patient with no apparent causes of sudden onset of vomiting of blood, the patient underwent four different treatment methods to stop the hemorrhage. The combined diagnosis of whole abdomen enhanced CT and angiography was calcified abdominal lymph nodes compressing the portal vein, leading to portal hypertension and resulting in esophageal and gastric variceal bleeding. Postoperatively, a biopsy of the caseous tubercular tissue of the abdominal wall observed intraoperatively was performed and the biopsy did not show a tubercular component. Therefore, the extensive intra-abdominal lymph node calcification was not associated with tuberculosis. The patient's bleeding ceased after surgery. CONCLUSION: This case has improved the clinician's understanding of the etiology of non-cirrhotic portal hypertension. Based on this, and with this case, the differences between various hemostatic measures were studied in depth.
Subject(s)
Esophageal and Gastric Varices , Hypertension, Portal , Tuberculosis , Abdomen/diagnostic imaging , Adult , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/therapy , Humans , Hypertension, Portal/complications , Lymph Nodes , Male , Portal Vein , Tuberculosis/complicationsABSTRACT
Objective:To explore the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of esophago-gastric variceal bleeding (EGVB) complicated with cavernous transformation of portal vein (CTPV).Methods:From January 1, 2015 to December 31, 2018, the clinical data of liver cirrhosis patients with EGVB and complicated with (CTPV group) or without (non-CTPV group) CTPV receiving TIPS at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were retrospectively analyzed. The success rate of operation, stent patency rate, recurrent bleeding rate, incidence and survival rate of hepatic encephalopathy of CTPV group and non-CTPV group were analyzed. Independent samples t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Kaplan-Meier method was used for survival analysis. Results:A total of 37 liver cirrhosis patients with EGVB and CTPV receiving TIPS treatment were screened out, among which 10 patients (27.0%) failed the portal vein puncture during the TIPS and switched to endoscopic treatment, the success rate was 73.0%. A total of 460 liver cirrhosis patients with EGVB and non-CTPV received TIPS treatment, among which TIPS in 18 patients (3.9%) was failed, and the success rate was 96.1%. With 1∶2 ratio propensity matching, 54 patients were enrolled in non-CTPV group. In the CTPV group, after TIPS treatment, the average portal vein pressure decreased from (28.9±5.1) mmHg (1 mmHg=0.133 kPa) to (18.8±4.5) mmHg, and the difference was statistically significant ( t=7.122, P<0.01). The median follow-up time was 33 months(1 to 66 months). There were no significant differences between the CTPV group and the non-CTPV group in one-year of cumulative stent patency rate (75.0% vs. 86.8%), recurrent upper gastrointestinal bleeding rate of hepatic encephalopathy (21.0% vs. 10.0%), the incidence of hepatic encephalopathy (34.8% vs. 22.2%) and the survival rate (80.7% vs. 88.9%)(all P >0.05). Conclusion:TIPS is safe and effective in the treatment of liver cirrhosis patients with EGVB and CTPV, and does not increase the incidence of postoperative complications and long-term mortality.
ABSTRACT
Objective To compare the short term and long term efficacy of drugs combined with endoscopic therapy (ET) and transjugular intrahepatic portosystemic shunt (TIPS) in treatment of esophageal and gastric variceal bleeding (EGVB) in cirrhotic patients. Methods We reviewed 120 cases of patients admitted for acute esophageal and gastric variceal bleeding from January 2010 to December 2014, treated with drugs combined with endoscopy (n = 77) or TIPS (n = 43). The incidence of failure to control bleeding, long term rebleeding, mortality and complications were compared. Results Patients treated with TIPS had a higher probability of remaining free of bleeding or rebleeding than patients receving drugs+ET (59.7％ vs. 81.4％, P < 0.05). The incidence of hepatic encephalopathy in the drugs + ET group was lower than that in the TIPS group (13.2％ vs 27.9％, P < 0.05). There was no significant difference in the control of acute bleeding (96.1％ vs 97.7％, P > 0.05) and mortality (10.4％ vs. 4.7％, P > 0.05) between the two groups. Conclusions Both drugs+ET and TIPS surgery can control EGVB well, TIPS can better prevent the occurrence of rebleeding but will lead to a higher incidence of hepatic encephalopathy.
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OBJECTIVE: To evaluate the cost-utility of terlypressin compared with somatostatin in the treatment of esophageal and gastric variceal bleeding(EGVB) in China. METHODS: A discrete event simulation model was created with four transition states: bleeding, no bleeding, rebleeding, and death. Transition probability of the model is derived from Meta analysis of the published literature. Used to calculate the quality of life in transition states health utility value source of literature. Cost data was sourced from (the listing price) of medical institutions. One-way sensitivity analyses were performed. RESULTS: In the base case scenario, results showed that terlypressin was more costly and more effective compared with somatostatin, and that incremental cost-utility ratios were 65 478.84 Yuan/QALY. Sensitivity analyses showed that the model was robust, and that all incremental cost-utility ratios were below 110 289.46 Yuan/QALYs, which is far less than three times gross domestic product (GDP) per capita in China. If using the treatment duration in the instructions to calculate drug costs in the sensitivity analysis, treatment with terlypression has lower cost and better effectiveness. CONCLUSION: The model indicates that terlypressin is most likely to be cost-effective versus somatostatin.
ABSTRACT
Objective To study the effect of modified air bag deflation lubrication by Sengstaken-Blakemore tube on voluntary dysphagia induced by esophageal variceal bleeding.Method Twenty seven patients with voluntary dysphagia induced by esophageal and gastric variceal bleeding were managed with modified air bag deflation lubrication with Sengstaken-Blakemore tube.Results The indwelling time for the Sengstaken-Blakemore tube was 3~6 d.There was no complication of gastrointestinal mucosal injury and aspiration complications.Conclusion The modified air bag deflation lubrication by Sengstaken-Blakemore tube may effectively avoid the complications by hemostasis with Sengstaken-Blakemore tube.
