The prognosis of liver cirrhosis depends on the presence of its major complications as well as on other factors such as hypersplenism with thrombocytopenia. Partial splenic embolization is an effective interventional procedure performed in liver cirrhosis complicated with portal hypertension to improve the low platelet count. This technique represents an efficient alternative to splenectomy, which has major drawbacks and is associated with a high morbidity. We report a series of patients with liver cirrhosis and portal hypertension who presented with severe thrombocytopenia and were treated with partial splenic embolization eventually having a favourable outcome.
Background: Many techniques have been used for liver parenchymal transection. It remains unknown which technique is superior with regards to perioperative outcomes. Vascular staplers have been used to perform liver parenchymal transection; however, evidence of their performance is still lacking. Methods: This is a single center, retrospective, comparative analysis of surgical outcomes of utilizing the stapler technique versus the harmonic scalpel for parenchymal transection during major hepatectomy. Results: Between 2011 and 2016, 176 patients with an otherwise healthy liver underwent right hepatectomy. A vascular stapler was used for parenchymal transection in 82 patients and the harmonic scalpel in 94 patients (control group). Morbidity, relaparotomy rate, and mortality were similar between groups. Median parenchymal transection time was shorter for patients undergoing stapled hepatectomy (7 vs 39 minutes, p<0.001). Median total operative time was also shorter (205 vs 255 minutes, p<0.001). Conclusion: Stapled parenchymal transection during major hepatectomy is feasible and safe. Transection and total operative times are significantly shorter when the stapler technique is employed. Morbidity and mortality rate are comparable between the two group. The stapler technique should be considered a standard method for liver parenchymal transection.
GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement.Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.
operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusion: Hepatic artery pseudoaneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.
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