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Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms
- Source :
- Revista Española de Enfermedades Digestivas. 111
- Publication Year :
- 2019
- Publisher :
- Sociedad Espanola de Patologia Digestiva (SEPD), 2019.
-
Abstract
- espanolIntroduccion: las comunicaciones porto-sistemicas congenitas intrahepaticas (sindrome de Abernethy) son variantes anatomicas muy poco frecuentes, estando clasificadas en funcion del tipo de union que exista entre la vena porta y el sistema venoso central. En el adulto, su diagnostico suele ser incidental, aunque algunos casos puede presentarse con clinica de encefalopatia en pacientes sin hepatopatia asociada. Casos clinicos: presentamos dos casos de shunt porto-sistemico, uno con desarrollo de encefalopatia y otro hallado de forma casual. Su tratamiento, por medio de radiologia intervencionista se decidio en funcion de si presentaban o no sintomatologia. Ambos casos (tratado y control) se presentan al control en consultas externas asintomaticos, sin asociar complicaciones derivadas de la decision terapeutica. Este control se realiza anualmente con pruebas de imagen (ecografia/TAC) y analisis sanguineo. Discusion: dada la escasa prevalencia de este tipo de malformacion y su diagnostico habitual en edades mas tempranas (asociada a importantes alteraciones cognitivas) su tratamiento en adultos no esta protocolizado. En estos casos la decision del tratamiento estaria condicionada a la sintomatologia asociada, siendo el tratamiento minimamente invasivo mediante radiologia intervencionista una opcion terapeutica a valorar en el adulto sintomatico. Por su parte la observacion por medio de pruebas de imagen y control en consultas externas, sin tratamiento asociado, seria de eleccion en adultos en los que no se presenta sintomatologia asociada. EnglishBackground: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. Case reports: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. Discussion: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults.
- Subjects :
- Male
medicine.medical_specialty
Vena porta
Vena cava
Septal Occluder Device
Vascular Malformations
Venous circulation
Vena Cava, Inferior
Asymptomatic
X ray computed
Humans
Medicine
Aged
Gynecology
Incidental Findings
Adult patients
Portal Vein
business.industry
Gastroenterology
Electroencephalography
Ultrasonography, Doppler
Syndrome
General Medicine
Middle Aged
Sindrome de
Hepatic Encephalopathy
Female
Symptom Assessment
medicine.symptom
Portosystemic shunt
Tomography, X-Ray Computed
business
Subjects
Details
- ISSN :
- 11300108
- Volume :
- 111
- Database :
- OpenAIRE
- Journal :
- Revista Española de Enfermedades Digestivas
- Accession number :
- edsair.doi.dedup.....b999dd14446712706a5d01385016e8cd
- Full Text :
- https://doi.org/10.17235/reed.2019.6210/2019