RESUMEN
In patients with cirrhosis and enterostomy, although bleeding stomal varices are rare, they can been severe and difficult to be treat. We report the first two cases of bleeding stomal varices treated by cyanoacrylate embolization, in patients with cirrhosis and colostomy. In each case, after pharmacological treatment of portal hypertension (propranolol) failed, embolization of the stomal varices by transdermal injection of biological glue effectively stopped the bleeding, without recurrence or side effects, after 8 and 16 months of follow-up. The embolization of stomal varices by biological glue is a safe, easy and efficient treatment for bleeding stomal varices.
Asunto(s)
Embolización Terapéutica/métodos , Enbucrilato/uso terapéutico , Hemorragia/terapia , Estomas Quirúrgicos/irrigación sanguínea , Adhesivos Tisulares/uso terapéutico , Várices/terapia , Anciano , Colostomía , Enbucrilato/administración & dosificación , Várices Esofágicas y Gástricas/terapia , Estudios de Seguimiento , Hemorragia Gastrointestinal/terapia , Humanos , Inyecciones , Cirrosis Hepática/cirugía , Masculino , Adhesivos Tisulares/administración & dosificación , Ultrasonografía IntervencionalRESUMEN
The infective agent responsible for cat scratch disease, Bartonella henselae, is a rare cause of hepatic granulomatosis in immunocompetent adults. Clinical features include a prolonged fever or more typical symptoms such as lymphadenopathy associated with painful hepatomegaly and a fever following a cat scratch or bite. Images of micronodular hepatosplenic lesions on abdominal ultrasonography or computed tomography scan along with epithelioid granulomas in a liver biopsy can suggest this diagnosis. It is established with a serology by indirect immunofluorescence or by ELISA and/or the presence of Bartonella henselae DNA evidenced by PCR in the liver biopsy. We report two cases of hepatosplenic localizations of cat scratch disease in a 41-year-old woman and a 44-year-old man presenting asthenia and fever associated with a biological inflammatory syndrome and elevated liver enzymes.