Hemorragia digestiva alta por várices gástricas secundarias a trombosis de vena esplénica tratada con esplenectomía / Upper gastrointestinal bleeding due to gastric varices secondary to splenic vein thrombosis treated by splenectomy

Upper gastrointestinal bleeding secondary to acute variceal hemorrhage is a medical emergency, with significant morbidity and mortality, which usually requires a multidisciplinary approach from gastroenterologists, intensive care physicians, and surgeons. The most common cause of variceal bleeding is the one that arises from portal hypertension associated with cirrhosis, and best described in terms of prevention, initial management and following treatment that in the minority of cases can be definitive without complex interventions, including liver transplant in cirrhotic patients. Within the etiologies not arising from portal hypertension, splenic vein thrombosis is one of the most important. Characterized by an endoscopic appearance of fundal or isolated gastric varices, without esophageal involvement, a variable number of cases manifest clinically as variceal hemorrhage. Based on different pathophysiology compared to esophageal varices, response to initial treatment is different, endoscopic management involve the use of adhesives (e.g. cyanoacrylate) as treatment of choice, and, in selected cases, surgical treatment can provide a definitive solution. Here we present a clinical case of an adult patient, without history of cirrhosis, who presented to the emergency department with severe upper gastrointestinal bleeding secondary to gastric varices, admitted in Intensive Care Unit and treated with endoscopy. Complementary studies with abdominal CT showed spleen vein thrombosis, enlarged spleen and multiple varicesin gastric body and fundus. After stabilization, splenectomy was performed as definitive treatment, with regression of gastric varices on ambulatory control with an upper endoscopy...

La hemorragia digestiva alta por sangrado variceal agudo constituye una emergencia médica, con morbimortalidad significativa asociada, requiriendo manejo multidisciplinario de gastroenterólogos, intensivistas y cirujanos. El sangrado variceal por hipertensión portal secundario a daño hepático crónico es el más habitual y mejor caracterizado en prevención, enfrentamiento inicial y manejo posterior, que en la minoría de los casos puede ser definitivo, sin intervenciones complejas, incluyendo trasplante hepático en pacientes cirróticos. Dentro de las causas de sangrado variceal no asociadas a hipertensión portal, la trombosis de vena esplénica es una de las principales. Caracterizada por presentarse en endoscopia como várices gástricas fúndicas o aisladas sin compromiso esofágico, se manifiestan clínicamente como sangrado variceal agudo en un porcentaje variable de casos. Por tener etiopatogenia distinta a las várices por hipertensión portal, la respuesta frente a las medidas terapéuticas iniciales es distinta, el tratamiento endoscópico de elección es el uso de adhesivos tipo cianoacrilato, y en casos seleccionados, el enfrentamiento quirúrgico puede ofrecer una solución definitiva. Presentamos el caso de una paciente sin antecedentes de daño hepático crónico, que se presentó con hemorragia digestiva alta por sangrado de várices gástricas, con manejo inicial en unidad de paciente crítico y hemostasia por vía endoscópica. En estudio complementario se objetivó trombosis de la vena esplénica con esplenomegalia y múltiples formaciones varicosas en fondo y cuerpo gástrico. Posterior a estabilización se realizó esplenectomía como manejo definitivo, logrando regresión de várices gástricas en endoscopia de control...

[Non-toxigenic hemolytic Vibrio cholerae non-O1 non-O139 fatal septicemia. Report of one case]. / Septicemia fatal causada por Vibrio cholerae no-O1, no-O139 hemolítico en Chile: Caso clínico.

We report a 70-year-old woman, who had recently consumed shellfish, that was admitted to the intensive care unit with septic shock and died 19 hours later due to a multi-organic failure. Microbiological, serological and molecular assays confirmed a hemolytic tdh+ Vibrio cholerae non-01, non 0139 as the etiologic agent.

Septicemia fatal causada por Vibrio cholerae no-O1, no-O139 hemolítico en Chile: Caso clínico / Non-toxigenic hemolytic Vibrio cholerae non-O1non-O139 fatal septicemia: Report of one case

We report a 70-year-old woman, who had recently consumed shellfish, that was admitted to the intensive care unit with septic shock and died 19 hours later due to a multi-organic failure. Microbiological, serological and molecular assays confirmed a hemolytic tdh+ Vibrio cholerae non-01, non 0139 as the etiologic agent (Rev Méd Chile 2009; 137: 1193-6).