The gastrointestinal bleeding in cirrhotic
La hemorragia digestiva en el cirrótico
Resumen:
The author presents a series of 197 cirrhotic patients describing complications, urgency medica! treatment, urgency surgery and deferred medica! treatments, indicating figures and percentages. 147 presented digestive hemorrhages ( 76.5 % ) ; 2 had varices which had not bled for 8 years; 1 had 4 hemorrhages in 10 years; 34 bled from causes otherthan varices (23.2 % ) : 13 erosive gastroenteritis (necropsy), 3 gastric neoplasms, 3 due to corticoids, 4 due to ulcers. 56 of these patients died as a consequenceof hemorrhages: 30 ( 53 6 % ) during the course of the first hemorrhage, 21 (37.7 % ) during the second and 5 ( 8.9 % ) during the third. 81 patients were examined for varices, by thefollowing 3 techniques and with 79 % visualization: splenoportography 64.l % ) , esophagoscopy 61.7 % and esophagrogram 37 % . Bleeding was found in 10· out of a total of 25 cirrhotic patients with anachlorohydria ( 40 % ) and in 5 out of 6 with hyperchlorohydria ( 83.3 % ) . Urgency medica! treatment of acute hemorrhage consisted ofSengstaken-Blackemore's baloon ( effective in 68.57 % cases), octopressine in 57.14 % ) and in a combination of both procedures ,effective in 88.8 % of cases. Urgency surgery consisted of azygo-portal disconnection in 14 cases, successful in stopping hemorrhages in 43 % of cases; direct ligation of varices and limphovenouscervical anastomosis, ( effective in cases of accitis that do not respond to medica! therapy) which failed; urgency porto-cava anastomosis, an elective procedure in sorne cases.Deferred medica! treatment was applied in 103 cases. There were 62 venous shunts 18 splenorenal, 44 portocava; best results were those obtained with terminolateralporto-cava. 7 patients have survived for over 8 years, 80 % had no bleeding, 32 % developed postoperatory hepatic encephalopathies in various degrees, 1 developed bleeding duodenal ulcer 2 years after shunt was performed. The author favours prophylactic shunt.
De 197 cirróticos con várices 147 ( 76.5 % ) presentar, on hemorragias digestivas; 2 llevan 8 años con várices sin sangrar, y 1 ha soportado 4 · hemorragiasen 10 años, 34 casos (23.2 % ) han sangrado por causa ajena a las várices; 13 gastritis erosivas (necropsia); 3 neoplasmas gástricos; 3 por corticoides; 4 por úlcera. 56 fallecieron a causa de la hemorragia; 30 (53.6 % ) en la primera hemorragia; 21 (37.7 % ) en la segunda; 5 ( 8.9 % ) en la tercera. En 81 cirrosis las várices se investigaron con las3 técnicas; la esplenoportografía las visualizó en el 64.1 % ; la esofagoscopía en el 61.7 % y el esofagograma e,i 37 % ; en el 79 % se visualizaron várices.De 25 cirróticos con anaclorhidria, sangraron 10: ( 40 % ) y de 6 con hipercolrhidria, sangraron 5 : (83.3 % ) . Tratamiento médico de urgencia de la hemorragia aguda: el Balón de Sangstaken-Blackemore fue efectivo en el 68.57 % de los casos; la Octopresina en el 57 .14 % ; ambos procedimientos combinados fueron efectivosen el 88.8 % . Cirugía de urgencia: se realizó desconexión azygoportal ( esqueletización) en 14 casos: en 43 % se detuvo la hemorragia. La ligadura directa de las váricesy la anastomosis linfovenosa cervical ( efectiva en las ascitis rebeldes a la terapia médica) han fracasado. Consideramos la anastomosis portocava de urgencia, en los casos apropiados como operación de elección. Tratamiento quirúrgico diferido: se realizaron en total 103, de <ellas, 62 shunt venoso: 18 esplenorrenales y 44 portocava; los mejores resultados con la• portocava terminolateral; 7 casos han sobrevivido por más de 8 años; 80 % no ha vuelto a sangrar. 32 % han presentado encefalopatía hepática postoperatoria dediverso grado. Un caso tuvo úlcera duodenal sangrante a los 2 años de shunt. Somos partidarios del shunt profilático.
1974 | |
hemorragia digestiva cirrosis digestive hemorrhage cirrhosis |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/2658 | |
Acceso abierto |