Asunto(s)
Diarrea , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias Duodenales , Úlcera Duodenal , Esomeprazol/administración & dosificación , Gastrinoma , Úlcera Péptica , Soluciones para Rehidratación/administración & dosificación , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Diarrea/metabolismo , Diarrea/fisiopatología , Diarrea/terapia , Neoplasias Duodenales/metabolismo , Neoplasias Duodenales/patología , Neoplasias Duodenales/fisiopatología , Neoplasias Duodenales/terapia , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/tratamiento farmacológico , Úlcera Duodenal/etiología , Úlcera Duodenal/fisiopatología , Duodeno/patología , Duodeno/cirugía , Endoscopía del Sistema Digestivo/métodos , Fluidoterapia/métodos , Gastrinoma/metabolismo , Gastrinoma/patología , Gastrinoma/fisiopatología , Gastrinoma/terapia , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Concentración Osmolar , Úlcera Péptica/diagnóstico , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/etiología , Úlcera Péptica/fisiopatología , Inhibidores de la Bomba de Protones/administración & dosificación , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Equilibrio HidroelectrolíticoAsunto(s)
Colecistitis Aguda/patología , Quistes/patología , Hepatopatías/patología , Hígado/anomalías , Dolor Abdominal/etiología , Adulto , Colecistitis Aguda/complicaciones , Colecistitis Aguda/cirugía , Quistes/complicaciones , Quistes/cirugía , Femenino , Gangrena/complicaciones , Gangrena/patología , Gangrena/cirugía , Humanos , Hepatopatías/complicaciones , Hepatopatías/cirugíaRESUMEN
Enterocolic lymphocytic phlebitis (ELP) is a rare cause of gastrointestinal ischemia. Unlike most vasculitic diseases affecting the gastrointestinal tract, ELP involves only the mural and mesenteric veins, which are surrounded by a lymphocytic and sometimes granulomatous infiltrate. The mesenteric arterial system and the systemic vasculature are characteristically spared. Most patients with ELP present with an acute abdomen that resolves following surgical resection of the involved bowel. ELP has been reported to involve the small bowel, colon, or both, but involvement of the upper gastrointestinal tract has not been previously described. Here we report a case of lymphocytic phlebitis that affected only the stomach and duodenum. The patient, a 68-year-old man, had a nonhealing gastric antral ulcer and underwent hemigastrectomy with vagotomy and Billroth II reconstruction. Both the resected stomach and duodenum showed characteristic lymphocytic and granulomatous infiltrates that involved the submucosal and mural veins, with associated obliteration of vascular lumina; the adjacent arteries were completely spared. The patient developed late postoperative complications including bile reflux gastritis and erosive esophagitis, but he had no recurrence of gastrointestinal ulceration or ischemia over a 2-year follow-up. We hypothesize that there may be more cases of upper gastrointestinal ELP than are diagnosed as such, in part because the diagnosis can be made only on surgical resections specimens.