Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia/métodos , Pâncreas/anormalidades , Pâncreas/cirurgia , Pancreatite/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Terapia Combinada , Endoscópios , Feminino , Humanos , Pancreatite/diagnóstico , Pancreatite/fisiopatologia , Recidiva , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of severe portal hypertension complications. Liver transplantation (LT) candidacy has not been a prerequisite to TIPS placement in some medical centers. OBJECTIVES: To investigate the outcome and survival of non-LT candidates after TIPS. METHODS: From November 1991 to February 1994, all patients referred for TIPS placement were evaluated for LT candidacy. Exclusions for LT included: age (> 70 yr), other significant medical conditions, or noncompliance. Indications for TIPS included refractory variceal bleeding during an acute bleed, recurrent bleeding after more than or equal to four sessions of sclerotherapy, or refractory ascites. RESULTS: Sixty patients received TIPS. Nineteen were considered non-LT candidates. Over a 2-yr follow-up, 14 of these non-LT candidates did not survive. Their median age was 63.5 compared with 56.5 yr for LT candidate nonsurvivors (p < 0.05). Among the 14 non-LT candidate nonsurvivors, 10 were Childs C class, and eight had emergent TIPS placement. The 2-year mortality rate was 84% for non-LT candidates versus 24% for LT candidates. Median survival time for non-LT candidates was 2.6 months compared with 20 months in the LT candidates (p < 0.001). Only one death was due to a TIPS-related complication. CONCLUSIONS: TIPS is unquestionably an advancement in the management of patients with portal hypertension complications. Non-LT candidates, compared with LT candidates, tended to be older and of a Child-Pugh C class, and they had survival rates often less than 90 days post-TIPS. Given these high mortality rates, we need to address whether TIPS is indicated in these non-LT candidates.
Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/cirurgia , Transplante de Fígado , Derivação Portossistêmica Cirúrgica , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/mortalidade , Tábuas de Vida , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Derivação Portossistêmica Cirúrgica/métodos , Derivação Portossistêmica Cirúrgica/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
It is well known that Crohn's disease can involve the duodenum, but isolated secondary complications such as pancreatitis or common bile duct obstruction have only rarely been reported, and never in the same patient. Herein, we describe a patient with duodenal Crohn's disease and both pancreatitis and calculous common bile obstruction. This unusual constellation of findings was managed with percutaneous techniques in which transhepatic catheterization of the bile duct permitted balloon dilatation of the ampulla of Vater, as well as a duodenal stricture. These maneuvers resulted in passage of the biliary stone and relief of the patient's symptoms. The management of this patient may serve as a guide possibly to delay or even prevent surgical intervention in similar cases of benign enteric strictures.
