Clinical characteristics of nonneoplastic cavernomatous transformation of the portal vein at a Gastroenterology Service in Spain.

OBJECTIVE: To identify predisposing factors, clinical characteristics and effective treatment in patients with nonneoplastic cavernomatous transformation of the portal vein in our gastroenterology service. METHODS: We retrospectively reviewed the clinical records of 2,201 patients diagnosed as having portal hypertension (2,165 with cirrhosis and 36 with noncirrhotic portal vein hypertension) during the period from 1977 to 1998. The diagnosis of cavernomatous transformation was confirmed with angiographic or Doppler echographic studies, or both. RESULTS: Thirteen patients (6 males, 7 females, age range 8 to 69 years) with cavernomatous transformation were found. Predisposing factors were omphalitis (1), echinococcal cyst (1), major abdominal surgery (3), liver cirrhosis (3), Sjögren syndrome (1), and no apparent cause (4). Eleven of the 13 patients had upper digestive tract bleeding from varices, 9 had splenomegaly, and 2 had cirrhotic decompensation. Splenectomy was done in 3 patients on admission, and in 5 patient shunts were used (splenorenal in 4, mesenteroatrial in 1) because of repeated bleeding. CONCLUSIONS: Of the patients with noncirrhotic portal hypertension, 27.7% had nontumoral cavernomatous transformation of the portal vein. Previous abdominal surgery was the most frequent predisposing factor; the 2 cases of echinococcal liver disease and Sjögren disease were exceptional. Age younger than 30 years, bleeding esophageal varices and splenomegaly were the most frequent clinical features. Portosystemic shunt was the only effective treatment alternative in these patients.

Características clínicas de la cavernomatosis portal no neoplásica en un servicio de Digestivo / Clinical characteristics of nonneoplastic cavernomatous transformation of the portal vein at a Gastroenterology Service in Spain

FUNDAMENTO: conocer las enfermedades predisponentes, las características clínicas y el tratamiento de los pacientes con cavernomatosis portal no neoplásica en nuestro Servicio de Digestivo. PACIENTES Y MÉTODOS: se revisan retrospectivamente los informes clínicos de 2.201 pacientes con el diagnóstico de hipertensión portal (2.165 con cirrosis y 36 con hipertensión portal no cirrótica) durante el período 1977-1998. El diagnóstico de cavernomatosis se confirmó por estudio angiográfico y/o ecografía Doppler. RESULTADOS: el número de pacientes con esta patología fue de 13 (seis varones y siete mujeres). La edad osciló entre 8 y 69 años. Las enfermedades predisponentes fueron onfalitis (uno), cirugía mayor abdominal (cuatro), cirrosis hepática (tres), síndrome de Sjögren (uno) y sin causa aparente (cuatro). De los 13, 11 presentaron hemorragia digestiva alta por varices, nueve esplenomegalia y dos descompensación cirrótica. En tres se hizo esplenectomía a su ingreso y en cinco derivaciones (cuatro esplenorrenales y uno mesentérico-atrial) por recidiva hemorrágica. CONCLUSIONES: de los enfermos con hipertensión portal no cirrótica, el 27,7 por ciento tuvo una cavernomatosis portal no turnoral. La cirugía abdominal previa fue la situación predisponente más habitual y dos casos de hidatidosis hepática y enfermedad de Sjögren son excepcionales. La edad menor de 30 años, las varices sangrantes y la esplenomegalia fueron las características clínicas más frecuentes. Las derivaciones portosistémicas son la única alternativa terapeútica definitiva en este tipo de pacientes (AU)

[Liver abscess caused by Streptococcus anginosus]. / Abscesos hepáticos por Streptococcus anginosus.

Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases. We report the case of a 77-year-old female with gastric cancer and liver abscesses by Streptococcus anginosus.

[Congenital intrahepatic venous shunt as a cause of hepatic encephalopathy]. / Derivación venosa intrahepática congénita como causa de encefalopatía hepática.

Macroscopic intrahepatic portosystemic shunts are extremely rare and may be due to liver injury, congenital vascular malformations or pathologic collaterals secondary to portal hypertension. Forty-eight cases have been reported in the literature up to 1994 with 50-60% presenting cerebral manifestations and 40% being associated with cirrhosis. The case of a patient without cirrhosis who was admitted for upper digestive hemorrhage secondary to gastroduodenal ulcer is described. At 48 hours the patient had an episode of hepatic encephalopathy coinciding with bleeding reactivation. Abdominal echography suggested communication between the right portal and suprahepatic veins and posterior angiography confirmed the diagnosis. Color Doppler echography determined shunt and portal vein blood flow. No case of intrahepatic portosystemic venous shunt as a cause of encephalopathy was found to have been reported in the Spanish literature.

[A consensus on Helicobacter pylori and gastroduodenal pathology]. / Consenso sobre Helicobacter pylori y patología gastroduodenal.

The current debate involving Helicobacter pylori (H.p.) and its potential role as an etiological factor for some digestive diseases, as well as the recent discussion through different mass media of this bacterium, including the American N.I.H. Consensus, have lead to the discussion of the H.p. problem, in order to clarify its real importance in acid-related diseases. Thus we want, as gastroenterologists, to give an overview of the current status, so as to facilitate the general practitioner work when confronted with gastrointestinal diseases, particularly related to H.p. Our purpose is to provide a critical and objective view regarding the implications of H.p. infection, and explain when treatment is needed and how this treatment should be accomplished.

[Somatostatin in the treatment of pancreatic ascites]. / La somatostatina en el tratamiento de la ascitis pancreática.

We present the case of a patient with alcoholic chronic pancreatitis who developed pancreatic ascites. The analysis of ascitic fluid was diagnostic; and ERCP showed one fistula in the pancreatic head to the peritoneal cavity. The patient was treated by continuous somatostatin infusion (250 micrograms/h) for 15 days resulting in the disappearance of the ascites and avoiding the risky surgical therapy.