The gastrointestinal bleeding in cirrhotic

La hemorragia digestiva en el cirrótico

Muñoz Monteavaro, Candido - Mescia, Carlos

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. 


Detalles Bibliográficos
1974
hemorragia digestiva
cirrosis
digestive hemorrhage
cirrhosis
Español
Sociedad de Cirugía del Uruguay
Revista Cirugía del Uruguay
https://revista.scu.org.uy/index.php/cir_urug/article/view/2658
Acceso abierto
_version_ 1815772763086913536
author Muñoz Monteavaro, Candido
author2 Mescia, Carlos
author2_role author
author_facet Muñoz Monteavaro, Candido
Mescia, Carlos
author_role author
collection Revista Cirugía del Uruguay
dc.creator.none.fl_str_mv Muñoz Monteavaro, Candido
Mescia, Carlos
dc.date.none.fl_str_mv 1974-02-24
dc.description.abstract.none.fl_txt_mv The author presents a series of 197 cirrhotic patients&nbsp;describing complications, urgency medica! treatment,&nbsp;urgency surgery and deferred medica! treatments,&nbsp;indicating figures and percentages.&nbsp;147 presented digestive hemorrhages ( 76.5 % ) ; 2&nbsp;had varices which had not bled for 8 years; 1 had 4&nbsp;hemorrhages in 10 years; 34 bled from causes otherthan varices (23.2 % ) : 13 erosive gastroenteritis (necropsy),&nbsp;3 gastric neoplasms, 3 due to corticoids, 4&nbsp;due to ulcers. 56 of these patients died as a consequenceof hemorrhages: 30 ( 53 6 % ) during the course&nbsp;of the first hemorrhage, 21 (37.7 % ) during the second&nbsp;and 5 ( 8.9 % ) during the third.&nbsp;81 patients were examined for varices, by thefollowing 3 techniques and with 79 % visualization:&nbsp;splenoportography 64.l % ) , esophagoscopy 61.7 % and&nbsp;esophagrogram 37 % .&nbsp;Bleeding was found in 10· out of a total of 25 cirrhotic&nbsp;patients with anachlorohydria ( 40 % ) and in&nbsp;5 out of 6 with hyperchlorohydria ( 83.3 % ) . Urgency&nbsp;medica! treatment of acute hemorrhage consisted ofSengstaken-Blackemore's baloon ( effective in 68.57 %&nbsp;&nbsp;cases), octopressine in 57.14 % ) and in a combination&nbsp;of both procedures ,effective in 88.8 % of cases.&nbsp;Urgency surgery consisted of azygo-portal disconnection&nbsp;in 14 cases, successful in stopping hemorrhages&nbsp;in 43 % of cases; direct ligation of varices and limphovenouscervical anastomosis, ( effective in cases of accitis&nbsp;that do not respond to medica! therapy) which&nbsp;failed; urgency porto-cava anastomosis, an elective&nbsp;procedure in sorne cases.Deferred medica! treatment was applied in 103 cases.&nbsp;There were 62 venous shunts 18 splenorenal, 44 portocava;&nbsp;best results were those obtained with terminolateralporto-cava. 7 patients have survived for over&nbsp;8 years, 80 % had no bleeding, 32 % developed postoperatory&nbsp;hepatic encephalopathies in various degrees,&nbsp;1 developed bleeding duodenal ulcer 2 years after&nbsp;shunt was performed.&nbsp;The author favours prophylactic shunt.
De 197 cirróticos con várices 147 ( 76.5 % ) presentar,&nbsp;on hemorragias digestivas; 2 llevan 8 años con&nbsp;várices sin sangrar, y 1 ha soportado 4 · hemorragiasen 10 años, 34 casos (23.2 % ) han sangrado por causa&nbsp;ajena a las várices; 13 gastritis erosivas (necropsia);&nbsp;3 neoplasmas gástricos; 3 por corticoides; 4 por úlcera.&nbsp;56 fallecieron a causa de la hemorragia; 30 (53.6 % )&nbsp;en la primera hemorragia; 21 (37.7 % ) en la segunda;&nbsp;5 ( 8.9 % ) en la tercera.&nbsp;En 81 cirrosis las várices se investigaron con las3 técnicas; la esplenoportografía las visualizó en el&nbsp;64.1 % ; la esofagoscopía en el 61.7 % y el esofagograma&nbsp;e,i 37 % ; en el 79 % se visualizaron várices.De 25 cirróticos con anaclorhidria, sangraron 10:&nbsp;( 40 % ) y de 6 con hipercolrhidria, sangraron 5 : (83.3 % ) .&nbsp;Tratamiento médico de urgencia de la hemorragia&nbsp;aguda: el Balón de Sangstaken-Blackemore fue efectivo&nbsp;en el 68.57 % de los casos; la Octopresina en el&nbsp;57 .14 % ; ambos procedimientos combinados fueron efectivosen el 88.8 % .&nbsp;Cirugía de urgencia: se realizó desconexión azygoportal&nbsp;( esqueletización) en 14 casos: en 43 % se detuvo&nbsp;la hemorragia. La ligadura directa de las váricesy la anastomosis linfovenosa cervical ( efectiva en las&nbsp;ascitis rebeldes a la terapia médica) han fracasado.&nbsp;Consideramos la anastomosis portocava de urgencia,&nbsp;en los casos apropiados como operación de elección.&nbsp;Tratamiento quirúrgico diferido: se realizaron en&nbsp;total 103, de &lt;ellas, 62 shunt venoso: 18 esplenorrenales&nbsp;y 44 portocava; los mejores resultados con la• portocava&nbsp;terminolateral; 7 casos han sobrevivido por más&nbsp;de 8 años; 80 % no ha vuelto a sangrar. 32 % han&nbsp;presentado encefalopatía hepática postoperatoria dediverso grado. Un caso tuvo úlcera duodenal sangrante&nbsp;a los 2 años de shunt. Somos partidarios del shunt&nbsp;profilático.&nbsp;
dc.format.none.fl_str_mv application/pdf
dc.identifier.none.fl_str_mv https://revista.scu.org.uy/index.php/cir_urug/article/view/2658
dc.language.iso.none.fl_str_mv spa
dc.publisher.none.fl_str_mv Sociedad de Cirugía del Uruguay
dc.relation.none.fl_str_mv https://revista.scu.org.uy/index.php/cir_urug/article/view/2658/2555
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.source.none.fl_str_mv Revista Cirugía del Uruguay; Vol. 44 No. 4 (1974): Cirugía del Uruguay; 278-288
Revista Cirugía del Uruguay; Vol. 44 Núm. 4 (1974): Cirugía del Uruguay; 278-288
1688-1281
reponame:Revista Cirugía del Uruguay
instname:Sociedad de Cirugía del Uruguay
instacron:Sociedad de Cirugía del Uruguay
dc.subject.none.fl_str_mv hemorragia digestiva
cirrosis
digestive hemorrhage
cirrhosis
dc.title.none.fl_str_mv The gastrointestinal bleeding in cirrhotic
La hemorragia digestiva en el cirrótico
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
dc.type.version.none.fl_str_mv info:eu-repo/semantics/publishedVersion
description The author presents a series of 197 cirrhotic patients&nbsp;describing complications, urgency medica! treatment,&nbsp;urgency surgery and deferred medica! treatments,&nbsp;indicating figures and percentages.&nbsp;147 presented digestive hemorrhages ( 76.5 % ) ; 2&nbsp;had varices which had not bled for 8 years; 1 had 4&nbsp;hemorrhages in 10 years; 34 bled from causes otherthan varices (23.2 % ) : 13 erosive gastroenteritis (necropsy),&nbsp;3 gastric neoplasms, 3 due to corticoids, 4&nbsp;due to ulcers. 56 of these patients died as a consequenceof hemorrhages: 30 ( 53 6 % ) during the course&nbsp;of the first hemorrhage, 21 (37.7 % ) during the second&nbsp;and 5 ( 8.9 % ) during the third.&nbsp;81 patients were examined for varices, by thefollowing 3 techniques and with 79 % visualization:&nbsp;splenoportography 64.l % ) , esophagoscopy 61.7 % and&nbsp;esophagrogram 37 % .&nbsp;Bleeding was found in 10· out of a total of 25 cirrhotic&nbsp;patients with anachlorohydria ( 40 % ) and in&nbsp;5 out of 6 with hyperchlorohydria ( 83.3 % ) . Urgency&nbsp;medica! treatment of acute hemorrhage consisted ofSengstaken-Blackemore's baloon ( effective in 68.57 %&nbsp;&nbsp;cases), octopressine in 57.14 % ) and in a combination&nbsp;of both procedures ,effective in 88.8 % of cases.&nbsp;Urgency surgery consisted of azygo-portal disconnection&nbsp;in 14 cases, successful in stopping hemorrhages&nbsp;in 43 % of cases; direct ligation of varices and limphovenouscervical anastomosis, ( effective in cases of accitis&nbsp;that do not respond to medica! therapy) which&nbsp;failed; urgency porto-cava anastomosis, an elective&nbsp;procedure in sorne cases.Deferred medica! treatment was applied in 103 cases.&nbsp;There were 62 venous shunts 18 splenorenal, 44 portocava;&nbsp;best results were those obtained with terminolateralporto-cava. 7 patients have survived for over&nbsp;8 years, 80 % had no bleeding, 32 % developed postoperatory&nbsp;hepatic encephalopathies in various degrees,&nbsp;1 developed bleeding duodenal ulcer 2 years after&nbsp;shunt was performed.&nbsp;The author favours prophylactic shunt.
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publishDate 1974
publisher.none.fl_str_mv Sociedad de Cirugía del Uruguay
reponame_str Revista Cirugía del Uruguay
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spelling The gastrointestinal bleeding in cirrhoticLa hemorragia digestiva en el cirróticoMuñoz Monteavaro, CandidoMescia, Carloshemorragia digestivacirrosisdigestive hemorrhagecirrhosisThe author presents a series of 197 cirrhotic patients&nbsp;describing complications, urgency medica! treatment,&nbsp;urgency surgery and deferred medica! treatments,&nbsp;indicating figures and percentages.&nbsp;147 presented digestive hemorrhages ( 76.5 % ) ; 2&nbsp;had varices which had not bled for 8 years; 1 had 4&nbsp;hemorrhages in 10 years; 34 bled from causes otherthan varices (23.2 % ) : 13 erosive gastroenteritis (necropsy),&nbsp;3 gastric neoplasms, 3 due to corticoids, 4&nbsp;due to ulcers. 56 of these patients died as a consequenceof hemorrhages: 30 ( 53 6 % ) during the course&nbsp;of the first hemorrhage, 21 (37.7 % ) during the second&nbsp;and 5 ( 8.9 % ) during the third.&nbsp;81 patients were examined for varices, by thefollowing 3 techniques and with 79 % visualization:&nbsp;splenoportography 64.l % ) , esophagoscopy 61.7 % and&nbsp;esophagrogram 37 % .&nbsp;Bleeding was found in 10· out of a total of 25 cirrhotic&nbsp;patients with anachlorohydria ( 40 % ) and in&nbsp;5 out of 6 with hyperchlorohydria ( 83.3 % ) . Urgency&nbsp;medica! treatment of acute hemorrhage consisted ofSengstaken-Blackemore's baloon ( effective in 68.57 %&nbsp;&nbsp;cases), octopressine in 57.14 % ) and in a combination&nbsp;of both procedures ,effective in 88.8 % of cases.&nbsp;Urgency surgery consisted of azygo-portal disconnection&nbsp;in 14 cases, successful in stopping hemorrhages&nbsp;in 43 % of cases; direct ligation of varices and limphovenouscervical anastomosis, ( effective in cases of accitis&nbsp;that do not respond to medica! therapy) which&nbsp;failed; urgency porto-cava anastomosis, an elective&nbsp;procedure in sorne cases.Deferred medica! treatment was applied in 103 cases.&nbsp;There were 62 venous shunts 18 splenorenal, 44 portocava;&nbsp;best results were those obtained with terminolateralporto-cava. 7 patients have survived for over&nbsp;8 years, 80 % had no bleeding, 32 % developed postoperatory&nbsp;hepatic encephalopathies in various degrees,&nbsp;1 developed bleeding duodenal ulcer 2 years after&nbsp;shunt was performed.&nbsp;The author favours prophylactic shunt.De 197 cirróticos con várices 147 ( 76.5 % ) presentar,&nbsp;on hemorragias digestivas; 2 llevan 8 años con&nbsp;várices sin sangrar, y 1 ha soportado 4 · hemorragiasen 10 años, 34 casos (23.2 % ) han sangrado por causa&nbsp;ajena a las várices; 13 gastritis erosivas (necropsia);&nbsp;3 neoplasmas gástricos; 3 por corticoides; 4 por úlcera.&nbsp;56 fallecieron a causa de la hemorragia; 30 (53.6 % )&nbsp;en la primera hemorragia; 21 (37.7 % ) en la segunda;&nbsp;5 ( 8.9 % ) en la tercera.&nbsp;En 81 cirrosis las várices se investigaron con las3 técnicas; la esplenoportografía las visualizó en el&nbsp;64.1 % ; la esofagoscopía en el 61.7 % y el esofagograma&nbsp;e,i 37 % ; en el 79 % se visualizaron várices.De 25 cirróticos con anaclorhidria, sangraron 10:&nbsp;( 40 % ) y de 6 con hipercolrhidria, sangraron 5 : (83.3 % ) .&nbsp;Tratamiento médico de urgencia de la hemorragia&nbsp;aguda: el Balón de Sangstaken-Blackemore fue efectivo&nbsp;en el 68.57 % de los casos; la Octopresina en el&nbsp;57 .14 % ; ambos procedimientos combinados fueron efectivosen el 88.8 % .&nbsp;Cirugía de urgencia: se realizó desconexión azygoportal&nbsp;( esqueletización) en 14 casos: en 43 % se detuvo&nbsp;la hemorragia. La ligadura directa de las váricesy la anastomosis linfovenosa cervical ( efectiva en las&nbsp;ascitis rebeldes a la terapia médica) han fracasado.&nbsp;Consideramos la anastomosis portocava de urgencia,&nbsp;en los casos apropiados como operación de elección.&nbsp;Tratamiento quirúrgico diferido: se realizaron en&nbsp;total 103, de &lt;ellas, 62 shunt venoso: 18 esplenorrenales&nbsp;y 44 portocava; los mejores resultados con la• portocava&nbsp;terminolateral; 7 casos han sobrevivido por más&nbsp;de 8 años; 80 % no ha vuelto a sangrar. 32 % han&nbsp;presentado encefalopatía hepática postoperatoria dediverso grado. Un caso tuvo úlcera duodenal sangrante&nbsp;a los 2 años de shunt. Somos partidarios del shunt&nbsp;profilático.&nbsp;Sociedad de Cirugía del Uruguay1974-02-24info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://revista.scu.org.uy/index.php/cir_urug/article/view/2658Revista Cirugía del Uruguay; Vol. 44 No. 4 (1974): Cirugía del Uruguay; 278-288Revista Cirugía del Uruguay; Vol. 44 Núm. 4 (1974): Cirugía del Uruguay; 278-2881688-1281reponame:Revista Cirugía del Uruguayinstname:Sociedad de Cirugía del Uruguayinstacron:Sociedad de Cirugía del Uruguayspahttps://revista.scu.org.uy/index.php/cir_urug/article/view/2658/2555info:eu-repo/semantics/openAccess2021-02-24T22:42:35Zoai:ojs2.revista.scu.org.uy:article/2658Privadahttps://scu.org.uy/https://revista.scu.org.uy/index.php/cir_urug/oaiUruguayopendoar:2021-02-24T22:42:35Revista Cirugía del Uruguay - Sociedad de Cirugía del Uruguayfalse
spellingShingle The gastrointestinal bleeding in cirrhotic
Muñoz Monteavaro, Candido
hemorragia digestiva
cirrosis
digestive hemorrhage
cirrhosis
status_str publishedVersion
title The gastrointestinal bleeding in cirrhotic
title_full The gastrointestinal bleeding in cirrhotic
title_fullStr The gastrointestinal bleeding in cirrhotic
title_full_unstemmed The gastrointestinal bleeding in cirrhotic
title_short The gastrointestinal bleeding in cirrhotic
title_sort The gastrointestinal bleeding in cirrhotic
topic hemorragia digestiva
cirrosis
digestive hemorrhage
cirrhosis
url https://revista.scu.org.uy/index.php/cir_urug/article/view/2658