Esplenomegalia El hiperesplenismo se caracteriza por: esplenomegalia. disminución de cifras de hematíes, leucocitos y plaquetas. Hiperesplenismo recurrente secundario a cardiomiopatia alcoholica despues de una anastomosis esplenorenal distal. Warren L. Garner. x. Warren L. Garner. vol número1 Hiperesplenismo secundario a compresión del eje esplenoportal por quiste hepático gigante Underwater hybrid endoscopic submucosal.

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Furthermore, tapering of the dilated intestine improves bowel motility, thus reducing hipperesplenismo risk of bacterial overgrowth. Am J Transplant ;15 1: The volume and calorie requirements were also reduced by half. The liver dysfunction was resolved via optimization of the parenteral formula.

J Pediatr Gastroenterol Nutr ;58 4: Due to the clinical scenario, the patient was placed on the intestinal transplant list combined with pancreas and kidney allografts. The mucosal surface is increased which results in an improved nutrient absorption.

In addition, the volume requirements were also reduced to less than half, with no negative impact on renal function. A year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. Postabsorptive plasma hiperesolenismo concentration is a marker of absorptive enterocyte mass and intestinal failure in humans.

The restoration of intestinal tract continuity is one of the mainstays of autologous gut reconstruction to obtain the absorptive and digestive properties of the colon. Herein, we report the first successful application of this novel technique in an adult with hipersplenismo and a dilated duodenum. The patient underwent duodenal lengthening and tapering with 7 sequential transverse applications 5 of 45 mm and 2 of 60 mm of an endoscopic stapler on the anterior and posterior walls of the duodenum, respecting the pancreatic parenchyma and end-to-side duodeno-colonic anastomosis.

V fluids for the remaining time. The final duodenal length was 83 cm.

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The classical standard duodenal tapering technique reduces the luminal diameter of the dilated duodenum by removing its anti-pancreatic border longitudinally, usually with stapler devices 8. Hypoglycemia during the PN-free period necessitated I. Comparison of intestinal hiperedplenismo procedures for patients with short bowel syndrome. A gastrostomy secunrario drained gastric and bilio-pancreatic secretions output range: The third portion of the duodenum had been stapled, leaving a duodenal stump.


A Jackson-Pratt drain was placed to detect postoperative leakage.

Although this young man may require an intestinal transplant in the future, the application of this procedure has resulted in an enormous social and psychological benefit as well as the avoidance of immunosuppression therapy. Antibiotics were secunddario postoperatively for 3 days. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction.

Nevertheless, the use of intestinal transplantation has declined in recent years due to the associated high morbidity and mortality that lead to poorer survival than that seen in patients on home PN 5 6.

July 27, ; Accepted: J Am Coll Surg ; Paseo Valle de Hebron, hiperesplenusmo Duodenal hipsresplenismo in short bowel with dilated duodenum.

Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome.

Alteraciones del bazo (esplenectomía) by Jean Carlo Rodriguez Vasquez on Prezi

However, the benefit of the procedure in the present case was questionable due to a complete absence of the small bowel and the presence of an incomplete megaduodenum. The secubdario of the retained duodenum measured from the pylorus was 30 cm.

The main advantage of this new technique is that an additional intestinal absorptive surface is obtained without the need to discard any duodenal portion. Its application in adults has been reported in the literature 3. In addition, the plasma citrulline level was An enema showing a defunctionalized transverse colon from the hepatic flexure.

Megaduodenum facilitates pyloric incompetence with eecundario reflux and dysmotility with stasis of intraluminal contents which may result in bacterial overgrowth and malabsorption.


Glycemia control continues to be as difficult as that experienced before surgery. In addition, he was diagnosed with type 1 diabetes at the age of 4 and had already developed incipient nephropathy in the form of microalbuminuria. A gastrostomy tube was left in place to facilitate drainage of gastric and bilio-pancreatic secretions.

Therefore, the overall time of parenteral nutrition PN and I. Ann Nutr Metab ; Only a megaduodenum stump that reached as far as the third portion 30 cm of length and the colon up to the hepatic flexure in the form of a mucous fistula was retained. Upper gastrointestinal tract X-rays and barium enema demonstrated a dilated and elongated duodenum and a small-caliber defunctionalized colon, respectively Fig.


In the present case, the pre-lengthening citrulline level had increased from The end result is the creation of a channel of bowel approximately twice the length and half the diameter of the original segment. After 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night. We have demonstrated the feasibility of lengthening the duodenum via a modified version of the original STEP in a subset of children with SBS and a dilated duodenum 4.

One question arises regarding the role of this surgical technique in the adaptation process. Upper gastrointestinal series prior to the duodenal lengthening procedure showing the massively dilated duodenum ending in a stump. Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children.

Since these anatomical structures are situated inside the thickness of the pancreatic parenchyma, the risk of injury is circumvented by stapling the anterior and posterior aspects of the duodenum at a sufficient distance from the pancreas.

The patient developed acute renal failure postoperatively and required hemodialysis for three months. Serial transverse enteroplasty for short bowel syndrome: The serial transverse enteroplasty procedure STEP is an intestinal lengthening procedure originally applied in pediatric patients with short secunadrio syndrome SBS and dilatation of the remnant small bowel. Secundxrio Pediatr Surg ; In summary, although this is only one case, the result obtained demonstrates the feasibility and effectiveness of duodenal tapering and lengthening as part of the autologous intestinal reconstruction armamentarium in adults with a dilated duodenum and SBS.