Hipertensión portal secundario a trombosis de la vena porta y várices esofágicas / Secondary portal hypertension to portal venous thrombosis and esophageal varices

Resumen La hipertensión portal se define como la alteración patológica en el gradiente de presión a nivel del sistema portal, es decir, la diferencia entre la presión de la vena porta y la vena cava inferior. El valor normal es entre 1-5 mm Hg y se considera hipertensión cuando es mayor de 10 mm Hg. En este artículo, se describe el caso de una paciente de 5 años con un cuadro de hipertensión portal secundario a várices esofágicas y trombosis de la vena porta, confirmado por endoscopia de vías digestivas alta y angioresonancia magnética. La paciente fue atendida en la Fundación Clínica Infantil Club Noel de la ciudad de Cali, Colombia, entre los meses de diciembre del 2018 y febrero del 2019.

Abstract Portal hypertension is defined as the pathological increase in the portal pressure gradient, which is the difference between the pressure of the portal vein and the inferior vena cava. Normally portal vein pressure ranges between 1-5 mmHg and is considered hypertension when it is higher than 10 mmHg. In this study the case of a 5-year-old patient that suffers from secondary portal hypertension to portal venous thrombosis and esophageal varices is presented. The diagnostic is confirmed by an endoscopy of the upper gastrointestinal tract and by a magnetic angioresonance. The patient was treated at the Fundacion Clinica Infantil Club Noel located in Cali, Colombia, between the months of December 2018 and February 2019.

Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis.

BACKGROUND AND AIM: Treatment for portal vein thrombosis (PVT) is not well established. Nevertheless, anticoagulation therapy can seemingly be used as first-line therapy. However, there are limited data on the role of this treatment in patients with PVT and cirrhosis. We sought to assess the safety and efficacy of anticoagulation therapy in a series of patients with non-malignant PVT and liver cirrhosis. METHODS: We analyzed the data of 32 patients with cirrhosis and PVT between March 2009 and September 2015. All patients received anticoagulation treatment. PVT was diagnosed within the context of biannual hepatocellular carcinoma screening in these patients. RESULTS: Recanalisation was achieved in 23 patients: complete in 17 patients (53.1%) and partial in 6 patients (18.7%). The median time for achieving a complete response was 7 months (95% CI: 6-8). We did not discover any risk factors associated with repermeation (partial or complete). None of the patients presented with thrombosis progression while receiving anticoagulation. Nine patients who achieved complete recanalisation and stopped anticoagulation therapy suffered rethrombosis (52%). There were no differences between the patients who achieved complete or partial recanalisation (35%) and those who did not (33%) in relation to the onset of hepatic events during follow-up. Three patients (9%) presented with bleeding complications: two variceal bleeding episodes and one brain hemorrhage. CONCLUSIONS: In cirrhotic patients with non-malignant PVT, anticoagulation therapy led to partial or complete recanalisation in 70% of patients, with a broad safety profile. Due to the existing rethrombosis rate, long-term anticoagulation should be considered.

Ultrasonografía vascular en pacientes con hepatopatías crónicas de causa desconocida / Vascular ultrasonography in patients with chronic hepatopathies of unknown etiology

Se realizó un estudio prospectivo y transversal de 69 pacientes con hepatopatías crónicas de causa desconocida, atendidos en el Departamento de Imagenología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2009 hasta agosto del 2010, a fin de determinar las alteraciones ultrasonográficas vasculares en los afectados. Predominaron el grupo etario de 52-59 años (39,1 por ciento), el sexo masculino (69,6 por ciento), la localización prehepática (44,9 por ciento), las trombosis de la vena porta (47 por ciento), la dilatación de venas suprahepáticas (89,7 por ciento) y las causas prehepáticas (44,9 por ciento). Las ecografías Doppler dúplex y Doppler color permitieron establecer pautas diagnósticas en estos pacientes, sin afectar el completamiento de su evaluación con otros estudios hemodinámicos(AU)

A prospective and cross-sectional study of 69 patients with chronic hepatopathies of unknown etiology, assisted in the Imagenology Department of Saturnino Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2009 to August, 2010, in order to determine the ultrasonographic vascular changes in the affected patients. The age group 52-59 (39.1 percent), the male sex (69.6 percent), the localization (44.9 percent), the thromboses of the portal vein (47 percent), the dilation of suprahepatic veins (89.7 percent) and the prehepatic etiologies (44.9 percent) prevailed. The Doppler duplex and Doppler colour echographies allowed to establish diagnostic criteria in these patients, without affecting their evaluation with other hemodynamic studies(AU)

Ultrasonografía vascular en pacientes con hepatopatías crónicas de causa desconocida / Vascular ultrasonography in patients with chronic hepatopathies of unknown etiology

Se realizó un estudio prospectivo y transversal de 69 pacientes con hepatopatías crónicas de causa desconocida, atendidos en el Departamento de Imagenología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero del 2009 hasta agosto del 2010, a fin de determinar las alteraciones ultrasonográficas vasculares en los afectados. Predominaron el grupo etario de 52-59 años (39,1 %), el sexo masculino (69,6 %), la localización prehepática (44,9 %), las trombosis de la vena porta (47%), la dilatación de venas suprahepáticas (89,7%) y las causas prehepáticas (44,9%). Las ecografías Doppler dúplex y Doppler color permitieron establecer pautas diagnósticas en estos pacientes, sin afectar el completamiento de su evaluación con otros estudios hemodinámicos.

A prospective and cross-sectional study of 69 patients with chronic hepatopathies of unknown etiology, assisted in the Imagenology Department of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2009 to August, 2010, in order to determine the ultrasonographic vascular changes in the affected patients. The age group 52-59 (39.1%), the male sex (69.6%), the localization (44.9%), the thromboses of the portal vein (47%), the dilation of suprahepatic veins (89.7%) and the prehepatic etiologies (44.9%) prevailed. The Doppler duplex and Doppler colour echographies allowed to establish diagnostic criteria in these patients, without affecting their evaluation with other hemodynamic studies.

Ascitis quilosa y trombosis de la vena porta en paciente con cirrosis hepática criptogénica / Ascites chylosus and thrombosis of portal vein in a patient with cryptogenic hepatic cirrhosis

Se presentó un paciente de 73 años de edad, de raza blanca, con ascitis quilosa, acompañada de insuficiencia hepática e hipertensión portal. Se evidenció la presencia de trombosis de la vena porta y varices esofágicas. Se notifica por lo infrecuente de la aparición de ascitis quilosa en pacientes con cirrosis hepática y su posible asociación con trombosis de la vena porta(AU)

This is the case of a white patient aged 73 presenting with chylosus ascites and liver failure and portal hypertension. It was evidenced la presence of thrombosis of portal vein and esophageal varices. It is noteworthy the non-frequent of chylosus ascites in patients presenting with liver cirrhosis and its possible association with a portal vein thrombosis(AU)

Ascitis quilosa y trombosis de la vena porta en paciente con cirrosis hepática criptogénica / Ascites chylosus and thrombosis of portal vein in a patient with cryptogenic hepatic cirrhosis

Se presentó un paciente de 73 años de edad, de raza blanca, con ascitis quilosa, acompañada de insuficiencia hepática e hipertensión portal. Se evidenció la presencia de trombosis de la vena porta y varices esofágicas. Se notifica por lo infrecuente de la aparición de ascitis quilosa en pacientes con cirrosis hepática y su posible asociación con trombosis de la vena porta

This is the case of a white patient aged 73 presenting with chylosus ascites and liver failure and portal hypertension. It was evidenced la presence of thrombosis of portal vein and esophageal varices. It is noteworthy the non-frequent of chylosus ascites in patients presenting with liver cirrhosis and its possible association with a portal vein thrombosis