RESUMEN
Fatal hemoperitoneum due to liver capsule perforation has been reported after transvenous liver biopsy. We report 2 cases of prophylactic embolization of such capsular gap. We propose the following techniques for embolization: detection of liver capsule puncture if the liver biopsy is difficult to perform because the liver is small or moves in ascites; and therapeutic embolization of detected capsular gap.
Asunto(s)
Biopsia/efectos adversos , Embolización Terapéutica , Hígado/lesiones , Biopsia/métodos , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Enfermedad Celíaca/fisiopatología , Vesícula Biliar/fisiopatología , Ultrasonografía , Adulto , Femenino , Humanos , MasculinoRESUMEN
Gallbladder emptying was evaluated in 15 adult celiac disease patients by oral cholecystography or ultrasonography, after fatty meal or cholecystokinin stimulation. Gallbladder inertia was found in 13 cases. Our study agrees with previously reported results; however it is the first one in which this abnormality was demonstrated by ultrasonography. Our findings may suggest that gallbladder inertia is due to duodenal release of an inactive endogenous cholecystokinin. Control studies demonstrates that gallbladder inertia is reversible after gluten-free diet, recurs with relapse, and thus represents a true celiac disease sign, and not an associated condition. Finally, our cases suggest that gallbladder inertia may be radiologically evident before clinical features of malabsorption become apparent. Awareness of this possibility may persuade the radiologist to research in this condition an occult celiac disease.
Asunto(s)
Discinesia Biliar/etiología , Enfermedad Celíaca/diagnóstico , Colecistografía , Enfermedades de la Vesícula Biliar/etiología , Vesícula Biliar/fisiopatología , Ultrasonografía , Adulto , Anciano , Discinesia Biliar/diagnóstico , Enfermedad Celíaca/diagnóstico por imagen , Colecistografía/métodos , Colecistoquinina/biosíntesis , Femenino , Enfermedades de la Vesícula Biliar/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.
Asunto(s)
Fístula Arteriovenosa/complicaciones , Colitis/etiología , Embolización Terapéutica/métodos , Hipertensión Portal/etiología , Arterias Mesentéricas/diagnóstico por imagen , Venas Mesentéricas/diagnóstico por imagen , Enfermedad Aguda , Fístula Arteriovenosa/terapia , Colon/irrigación sanguínea , Femenino , Humanos , Isquemia/etiología , Persona de Mediana Edad , RadiografíaRESUMEN
A case of bleeding cecal typhoid ulcer in a 22-year-old patient demonstrated by superior mesenteric arteriography is described. An attempt to stop hemorrhage using intraarterial vasopressin infusion, failed. However, arteriography proved helpful in locating the bleeding site, and in permitting conservative surgery, namely cecal ulcer suture to achieve hemostasis. On the basis of this case and a review of the literature, management of complicating hemorrhage resulting from typhoid fever is discussed, with particular reference to radiological procedures.