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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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The patient developed acute renal failure postoperatively and required hemodialysis for three months.

J Pediatr Surg ; The next firing was similar from the opposite side, creating a duodenal channel 3 cm in diameter. A 25 year old man with extreme SBS on total parenteral nutrition TPN secondary to mid-gut volvulus at the age of 19 was referred to our center for intestinal transplant evaluation. Duodenal lengthening in short bowel with dilated duodenum.

Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte hipereesplenismo and intestinal failure in humans.

Esplenomegalia – Wikipedia, a enciclopedia libre

Herein, we report the first successful application of this novel technique in an adult with ultra-SBS and a dilated duodenum. Comparison of intestinal hiperesplennismo procedures for patients with short bowel syndrome.

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.

Ann Nutr Metab ; The serial transverse enteroplasty procedure STEP is an intestinal lengthening procedure originally applied secundsrio pediatric patients with short bowel syndrome SBS and dilatation of the remnant small bowel.

A year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. He also follows an oral low-fiber diet ad libitum.

Creatinine clearance has remained unchanged from that observed prior to surgery and the liver function test secyndario normal.

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Although the duodenum is a challenging segment in autologous gut reconstruction due to its close proximity to bilio-pancreatic structures and the blood supply shared with the pancreas. J Pediatr Gastroenterol Nutr ;58 4: One question arises regarding the role of this surgical technique in the adaptation process.


Apart from insulin, the only drugs administered are proton pump inhibitors. The postoperative course was uneventful. Measurement of plasma citrulline a non-protein amino acid mainly produced by enterocytes of the small bowel has been proposed as a biomarker of remnant small bowel mass and predicts permanent versus transient intestinal failure 9 Serum liver function test was as follows: At 12 months post-surgery, citrulline plasma level had increased to The pre-lengthening citrulline level increased from Serial transverse duodenoplasty not only gains an additional intestinal length when combined with simultaneous STEP but can also be applied successfully in patients with ultra-SBS.

Written informed consent was obtained from the patient prior to the procedure. Nevertheless, due to our prior successful experience with duodenal lengthening procedures in children 4the patient asked to be considered for duodenal lengthening.

An enema showing a defunctionalized transverse colon from the hepatic flexure.


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 secundaario. This technique increases bowel length via the application of sequential stapling on alternating sides in a plane perpendicular to hiperespleinsmo long axis of the bowel. Although, the patient is able to successfully treat hypoglycemia episodes via the oral route.

A gastrostomy tube was left in place to facilitate drainage of gastric and bilio-pancreatic secretions. With a follow-up of 24 months, the patient currently hipeesplenismo 47 kg and leads a normal life. The end result is the creation of a channel of bowel approximately twice the length and half the diameter of the original segment.

The volume and calorie requirements were also reduced by half. 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.

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

This is an open-access article distributed under the terms of the Creative Commons Attribution License. This procedure is reserved for cases with life-threatening complications from TPN. Prior to surgery, he had a history of 3 central-line infections and was colonized by multi-resistant Klebsiella pneumoniae. Due to the clinical scenario, the patient was placed on the intestinal transplant list combined with pancreas and kidney allografts.


J Am Coll Surg ; In the present case, the pre-lengthening citrulline level had increased from The final duodenal length was 83 cm.

Glycemia control continues to be as difficult as that experienced before surgery. The lengthened duodenum measured 83 cm. The vertexes of the cutting line were reinforced with a vicryl U stitch to prevent duodenal leaks. An iterative mid-line incision was made under general anesthesia. Megaduodenum facilitates pyloric incompetence with alkaline reflux and dysmotility with stasis of intraluminal contents which may result in bacterial overgrowth and malabsorption.

In the present case, the need for a simultaneous pancreas and kidney transplant was based on the difficulty of diabetes control and problematic future scenario of adverse effects of immunosuppressors post-transplant due to chronic nephropathy. Hypoglycemia during the PN-free period necessitated I. A radiologic gastrointestinal contrast study on the 7th postoperative day ruled out stricture or leakage before the initiation of enteral nutrition Fig.

The length of the retained duodenum measured from the pylorus was 30 cm. To date, there are no reported experiences of duodenal lengthening in adults. The main advantage of this new technique is that an additional intestinal absorptive surface is obtained without the need to discard any duodenal portion. The liver dysfunction was resolved via optimization of the parenteral formula. Its application in adults has been reported in the literature 3.