Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Isquemia mesentérica crónica, tratamiento quirúrgico: reporte de dos casos / Chronic mesenteric ischemia: report of two cases

Chronic mesenteric ischemia is uncommon and often not recognized by clinicians. We report two patients with the disease. A 61 years old female with a two years history of abdominal pain, diarrhea, anorexia and weight loss. A mesenteric arteriography showed a critical stenosis of the celiac artery. The patient was operated and a retrograde bypass from the iliac to the mesenteric artery was placed. Digestive symptoms ceased and the patient gained weight. A 49 years old smoker female, with a two years history of abdominal pain and weight loss, without diarrhea. A doppler ultrasonography of abdominal arteries showed a critical stenosis of the celiac artery. The angiography confirmed the stenosis and disclosed also a complete occlusion of the common hepatic artery. The patient was operated placing anterograde aortic-mesenteric and aortic- hepatic bypasses. During the follow up, the patient is in good conditions.

La isquemia mesentérica crónica es una enfermedad que pone en riesgo la vida, que puede provocar la muerte por inanición o infarto mesentérico. El diagnóstico se realiza tardíamente debido a la inespecificidad de sus síntomas. El método diagnóstico no invasivo de elección es la ecografía doppler, por el cual se determina la presencia de estenosis u oclusión de las arterias viscerales comprometidas. La arteriografía se utiliza para definir la anatomía de las lesiones y planificar la cirugía. El tratamiento de elección sigue siendo la revascularización. Presentamos dos pacientes tratadas en nuestro servicio con buenos resultados, las que presentaban historia de síntomas abdominales inespecíficos y baja de peso. En la primera paciente, con antecedentes de hipercolesterolemia, su estudio demostró ateromatosis calcica difusa de aorta abdominal, ilíacas comunes, tronco celíaco, renales y mesentérica superior; se le realizó bypass ilíaco-mesentérico superior. En la segunda paciente, con antecedentes de tabaquismo crónico, su estudio demostró lesiones críticas de tronco celíaco y arteria mesentérica superior e inferior, se le realizó bypass aorto-mesentérico superior y aorto-hepático común. En los controles, ambas pacientes presentan alza de peso sostenida y se mantienen asintomáticas.

Trombosis venosa mesentérica: manifestaciones clínicas, terapia y evolución / Mesenteric vein thrombosis: clinical manifestations, treatment and outcome

Background: Mesenteric vein thrombosis (MVT) is uncommon and accounts for 5-10percent of all mesenteric ischemic events. In 80percent of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery. Aim: To describe the clinical characteristics of patients with MVT. Patients and methods: Retrospective and prospective review of all cases with MVT, treated between 1995-2001. The clinical presentation, imaging studies, treatment and outcome were evaluated. Results: 29 cases of MVT were reviewed (14 females, age 56 ± 15 years). Twenty two patients (76percent) had recognizable risk factors. The main symptoms were abdomianl pain (86percent) and vomiting (55percent). The diagnosis of acute mesenteric ischemia was suspected on admission only in 6 patients (21percent). Thirteen patients underwent transabdominal color Doppler ultrasonography and the diagnosis was confirmed for 11 of these (85percent). Twenty out of 24 patients (85percent) studied with computed tomography, had positive signs of MVT. Twenty one patients (72percent) recieved anticoagulation, 10 of whom also underwent surgery. Four patients (14percent) received surgical treatment alone. Four patients were not treated. Seven patients (24percent) died. Conclusions: MVT is difficult to identify. It is necessary to have a high degree of suspicion in patients who have risk factors. The diagnosis is made with imaging studies. The treatment consists of early anticoagulation and surgical intervention when indicated.

Isquemia mesentérica crónica: caso clínico / Chronic mesenteric ischemia: a clinical case

Se presenta un caso clínico de isquemia mesentérica crónica, catalogado como "Angina Intestinal" típica, diagnosticado y tratado en el Hospital Naval de Valparaíso. Se discute sobre la forma de presentación clínica de estos pacientes, analizando en forma breve los principales síntomas que caracterizan esta enfermedad y se comentan aspectos importantes a considerar en la reparación quirúrgica. Consideramos como excelente el resultado inicial del tratamiento en este caso, ya que nuestra paciente se encuentra libre de síntomas, a los diez meses de operación