Trombosis venosa portal extrahepática, manejo quirúrgico con derivación meso-Rex. Serie de 3 casos

extrahepatic venous thrombosis

Autores/as

DOI:

https://doi.org/10.30944/20117582.574

Palabras clave:

meso-Rex, vena porta, trombosis venosa, derivación portocava quirúrgica, várices

Resumen

La vena porta es un conducto que drena el flujo esplácnico al hígado y se puede ocluir por diferentes patologías, variando su presentación clínica de acuerdo con la causa de la obstrucción. Es muy importante diferenciar la trombosis portal asociada o no a la cirrosis, ya que su tratamiento y pronóstico es diferente. La trombosis venosa portal extrahepática es una condición netamente de origen vascular, y es la principal causa de trombosis portal en niños y adultos. Presentamos tres casos tratados con derivación meso-Rex, con seguimiento a 6 meses.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

César Jiménez, Hospital Universitario Clínica San Rafael, Bogotá, D.C., Colombia

Médico, especialista en Cirugía vascular, Hospital Universitario clínica de San Rafael, Bogotá, D.C., Colombia.

Leonardo Randial, Hospital Universitario clínica de San Rafael, Bogotá, D.C. Colombia

Jefe, Servicio de cirugía vascular, Hospital Universitario clínica de San Rafael, Bogotá, D.C. Colombia

Iván Silva, Hospital Universitario clínica de San Rafael, Bogotá, D.C. Colombia

Médico, especialista en Cirugía vascular, Hospital Universitario clínica de San Rafael, Bogotá, D.C., Colombia.

Manuel Hossman-Galindo, Hospital Universitario clínica de San Rafael, Bogotá, D.C. Colombia

Médico, especialista en Cirugía vascular, Hospital Universitario clínica de San Rafael, Bogotá, D.C., Colombia.

Mario Bravo, Hospital Universitario clínica de San Rafael. Bogotá, D.C., Colombia

Médico hospitalario, Servicio de cirugía vascular, Hospital Universitario clínica de San Rafael. Bogotá, D.C., Colombia.

Osiris Moreno, Universidad del Bosque. Bogotá, D.C., Colombia

Médico, residente de Cirugía general, Universidad del Bosque. Bogotá, D.C., Colombia

Referencias bibliográficas

Chawla Y, Bodh V. Portal Vein Thrombosis, Portal Vein Thrombosis. J Clin Exp Hepatol. 2015;5:22-40. https://doi.org/10.1016/j.jceh.2014.12.008

Boley SJ, Brant LJ, Sammartano RJ. History of mesenteric ischemia: evolution of a diagnosis and management. Surg Clin N Am. 1997;77:275-87. https://doi.org/10.1016/S0039-6109(05)70548-X

Webb LJ, Sherlock S. The aetiology, presentation and natural history of extra hepatic portal venous obstruction. Q J Med. 1979;192:627-39.

Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006;12:2115-9. https://doi.org/10.3748/wjg.v12.i13.2115

Hoekstra H, Janssen L. Vascular liver disorders (II): portal vein thrombosis. J Med (Netherlands). 2009;67:46-53.

Chawla Y, Duseja A, Dhiman K. Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther. 2009;30:881-94. https://doi.org/10.1111/j.1365-2036.2009.04116.x

Yong-Pil C, Tae-Yong H, Gi-Young K, Kim K, Sung L. Use of meso-Rex shunt with transposition of the coronary vein for the management of extrahepatic portal vein obstruction. Ann Surg Treat Res. 2014;86:105-8.

https://doi.org/10.4174/astr.2014.86.2.105

Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-52. https://doi.org/10.1016/j.jhep.2015.05.022

Franchis R, Pascal JP, Ancona E, Burroughs AK, Henderson JM, Fleig W, et al. Definitions, methodology and therapeutic strategies in portal hypertension. A consensus development workshop, Baveno, Lake Maggiore, Italy, April 5 and 6, 1990. J Hepatol. 1992;15:256-61. https://doi.org/10.1016/0168-8278(92)90044-P

Garcia-Tsao G, Bosch J, Groszmann R. Portal hypertension and variceal bleeding, unresolved issues. Summary of an American Association for the study of liver disease and of the European Association for the Study of the Liver single-topic conference. Hepatology. 2008;47:1764-72. https://doi.org/10.1002/hep.22273

Seijo-Rios S, Garcıa-Pagan JC. Trombosis portal. Gastroenterol Hepatol. 2010;33:179-90. https://doi.org/10.1016/j.gastrohep.2009.04.002

Webster G, Burroughs K, Riordan M. Review article: portal vein thrombosis - new insights into aetiology and management. Aliment Pharmacol Ther. 2005;21:1-9. https://doi.org/10.1111/j.1365-2036.2004.02301.x

Wolter K, Decker G, Kuetting D, Trebicka J, Manekeller S. Interventional treatment of acute portal vein thrombosis. Fortschr Röntgenstr. 2018;190:740-6. https://doi.org/10.1055/a-0631-9265

Lang S, Loss M, Wohlgemuth W, Schlift H. Clinical management of acute portal/mesenteric vein thrombosis. Viszeralmedizin. 2014;30:394-400. https://doi.org/10.1159/000369896

Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 2013; 34:11-29. https://doi.org/10.1055/s-0032-1325499

Parenti C. Evaluation of Rex Shunts: What Sonographers Need to Know J Diagnostic Medical Sonography. 2013;29:238-42. https://doi.org/10.1177/8756479313497429

Berzigotti A, Garcia-Criado A, Darnell A, Garcia- Pagan JC. Imaging in clinical decision-making for portal vein thrombosis. Nat Rev Gastroenterol Hepatol. 2014;11:308-16. https://doi.org/10.1038/nrgastro.2013.258

Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013;88:285-94. https://doi.org/10.1016/j.mayocp.2013.01.012

Tae-Yong H, Kim H, Gi-Young K, Seak O. Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction: a retrospective observational study. BMC Surgery. 2015;15:116. https://doi.org/10.1186/s12893-015-0101-6

Sundeep J, Kalla M, Suleman A. Proximal spleno-renal shunt with retroaortic left renal vein in a patient with extrahepatic portal vein obstruction: first case report. BMC Surgery. 2017;17:65. https://doi.org/10.1186/s12893-017-0262-6

Wang M, Lin H, Guo L, Liu F. Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach, World J Gastroenterol. 2009;15:3038-45. https://doi.org/10.3748/wjg.15.3038

Turnes J, Garcıa-Pagan JC, Gonzalez M, Aracil C, Calleja JL, Ripoll C, et al. Portal hypertension-related complications after acute portal vein thrombosis: Impact of early anticoagulation. Clin Gastroenterol Hepatol. 2008;6:1412-7. https://doi.org/10.1016/j.cgh.2008.07.031

Plessier A, Murad SD, Hernandez-Guerra M, Consigny Y, Fabris F, Heller J, et al. A prospective multicentric follow up study on 105 patients with acute portal vein thrombosis: results from EN-VIE. Hepatology. 2007;46(suppl):310A.

Chung JW, Kim GH, Lee JH, Ok KS, Jang ES, Jeong SH, et al. Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis. Clin Mol Hepatol. 2014;20:384-91. https://doi.org/10.3350/cmh.2014.20.4.384

Rosenqvist K, Eriksson LG, Rorsman F, Sangfelt P, Nyman R. Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver. Acta Radiol. 2016;57:572-9. https://doi.org/10.1177/0284185115595060

Kim HS, Patra A, Khan J, Arepally A, Streiff MB. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol. 2005;16:1685-91. https://doi.org/10.1097/01.RVI.0000182156.71059.B7

Harmanci O, Bayraktar Y. Portal hypertension due to portal venous thrombosis: Etiology, clinical outcomes. World J Gastroenterol. 2007;13: 2535-40. https://doi.org/10.3748/wjg.v13.i18.2535

de Goyet J, Clapuyt P, Otte JB. Extrahilar mesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant. Transplantation. 1992;53:231-2.

Chiu B, Pillai SB, Sandler AD, Superina RA. Experience with alternate sources of ve¬nous inflow in the meso-Rex bypass operation: the coronary and splenic veins. J Pediatr Surg. 2007;42:1199-202. https://doi.org/10.1016/j.jpedsurg.2007.02.033

Prasad A, Gupta S, Kohli V, Girish K. Proximal Splenorenal Shunts for Extrahepatic Portal Venous Obstruction in Children. Ann Surg. 1994;219:193-6. https://doi.org/10.1097/00000658-199402000-00011

López-Santamaría M, Gámez M, Murcia J, Frauca E, Hierro L, Camarena C, de la Vega A, et al. Hipertensión portal prehepática como complicación tardía del trasplante hepático pediátrico Cir Pediatr 2001;14:135-8.

Caronna R, Bezzi M, Schiratti M, Cardi M, Prezioso G, Benedetti M, et al. Severe bleeding from esophageal varices resistant to endoscopic treatment in a non cirrhotic patient with portal hypertension. World J Emerg Surg. 2008,3:24. https://doi.org/10.1186/1749-7922-3-24

Hau M, Fellmer P, Schoenberg M, Schmelzle M, Morgul M. The collateral caval shunt as an alternative to classical shunt procedures in patients with recurrent duodenal varices and extrahepatic portal vein thrombosis. Eur J Med Res. 2014;19:36. https://doi.org/10.1186/2047-783X-19-36

Belli L, Puttini M, Marni A: Extrahepatic portal obstruction: clinical experience and surgical treatment in 105 patients. J Cardiovasc Surg (Torino). 1980;21:439-48.

Han D, Tang R, Wang L, Li A, Huang X, Shen S, et al. Case report of a modified Meso-Rex bypass as a treatment technique for late-onset portal vein cavernous transformation with portal hypertension after adult deceased-donor liver transplantation. Medicine. 2017;96:e7208. https://doi.org/10.1097/MD.0000000000007208

Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol. 2002;97:535-41. https://doi.org/10.1111/j.1572-0241.2002.05527.x

Wei Z, Guang R, Zhang Y, Li D, Liu Q. Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass: A clinical observational study. Med Sci Monit. 2014;20:2235-42. https://doi.org/10.12659/MSM.892482

Superina R, Bambini DA, Lokar J, Rigsby C, Whitington PF. Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass. Ann Surg. 2006;243:515-21. https://doi.org/10.1097/01.sla.0000205827.73706.97

Domínguez-Amillo C, De la Torre R, Moreno A, Encinas-Hernandez JL. Resultados del shunt mesoportal de Rex en el tratamiento de la trombosis portal extrahepática idiopática. Cir Pediatr. 2017;30:22-7.

Salzedas-Netto AA, Duarte AA, Linhares MM, Mattar RH, Medeiros KL, Cury EK, et al. Variation of the Rex shunt for treating concurrent obstruction of the portal and superior mesenteric veins. J Pediatr Surg. 2011;46:2018-20. https://doi.org/10.1016/j.jpedsurg.2011.07.002

Ateş O, Hakgüder G, Olguner M, Seçil M, Karaca I, Akgür FM. Mesenterico left portal bypass for variceal bleeding owing to extrahepatic portal hypertension caused by portal vein thrombosis. J Pediatr Surg. 2006;41:1259-63. https://doi.org/10.1016/j.jpedsurg.2006.03.043

Zhang H, Zhang N, Li M, Jin W, Pan S. Surgical treatment of portal vein cavernous transformation. World J Surg. 2004;28:708-11. https://doi.org/10.1007/s00268-004-7265-z

Boyer TD, Habib S. Big spleens and hypersplenism: fix it or forget it? Liver International. 2015;35:1492-8. https://doi.org/10.1111/liv.12702

Omer S, Zara O, Lacobescu C, Dina I. Partial splenic embolization for hypersplenism in cirrhotic patients. A case series. J Gastrointestin Liver Dis. 2014;23:215-8. https://doi.org/10.15403/jgld.2014.1121.232.so1

Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med. 2001;345:1683-8. https://doi.org/10.1056/NEJMra010076

Poddar U, Thapa BR, Singh K. Band ligation plus sclerotherapy versussclerotherapy alone in children with extrahepatic portal venous obstruction. J Clin Gastroenterol. 2005;39:626-9.

https://doi.org/10.1097/01.mcg.0000170765.36825.66

Spaander MC, Darwish Murad S, van Buuren HR, Hansen BE, Kuipers EJ, Janssen HL. Endoscopic treatment of esophagogastric variceal bleeding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study. Gastrointest Endosc. 2008;67:821-7. https://doi.org/10.1016/j.gie.2007.08.023

Descargas

Publicado

2021-01-07

Cómo citar

(1)
Jiménez Jiménez, C. E.; Randial Tagliapetra , L. .; Silva Restrepo, I. E. .; Hossman-Galindo, M. A. .; Bravo, M. .; Moreno Beltrán, O. Trombosis Venosa Portal extrahepática, Manejo Quirúrgico Con derivación Meso-Rex. Serie De 3 Casos: Extrahepatic Venous Thrombosis. Rev Colomb Cir 2021, 36, 98-109.

Número

Sección

Artículo Original

Métricas

QR Code