Volume 73 - 2010 - Fasc.1 - Case reports
Rapidly evolving liver decompensation with some remarkable features 14 years after biliopancreatic derivation: a case report and literature review.
Because of the rising incidence of obesity the use of bariatric sur- gery is also increasing. For the obese it is the only treatment with a proven long-term benefit on weight, comorbidities including non alcoholic steatohepatitis, and long-term mortality.
There are, however, several reports on hepatic complications after bariatric surgery leading to malabsorption. The risk of liver decompensation or cirrhosis is one of the reasons jejunoileal bypass has been abandoned. Hepatic complications following Roux-en-Y gastric bypass and biliopancreatic derivation (BPD) are also reported but never beyond 2 years of follow-up. There is only one confirmed case of development of cirrhosis following BPD which presented 10 months after surgery.
We present a case of a 39-year-old patient who developed rapidly evolving, and ultimately fatal, liver decompensation in previously unknown cirrhosis, 14 years after BPD. This is the first report of a severe hepatic complication such a long time after a BPD.
Existing literature on hepatic complications after bariatric surgery is discussed as are 2 coincidental findings of pronounced ductular reaction on histology and autoimmune haemolytic anaemia. (Acta gastroenterol. belg., 2010, 73, 46-51).
Hepatic amyloidosis increases liver stiffness measured by transient elastography
Liver stiffness values in transient elastography (TE) have to be interpreted with caution. Steatosis, congestion, acute inflammation and extrahepatic cholestasis can indeed influence measurements. Obtained stiffness values in the cirrhotic range can also be present in the absence of fibrosis as in hepatic amyloidosis. Here we report two cases of systemic amyloidosis with hepatic involvement where high stiffness values were measured at TE. In fact, deposits of amy- loid may increase the rigidity of the liver parenchyma resulting in higher liver stiffness values.
Therefore, results of TE should always be interpreted in their clin- ical context and if inconsistent, the performance of a liver biopsy might be necessary. (Acta gastroenterol. belg., 2010, 73, 52-54).
An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases
We report on 2 cases of visceral arterial embolism presenting with acute abdominal pain. In neither patient a cause could be established on initial clinical, laboratory, echograpic or radiologi- cal investigation. Both patients were subsequently found to have a mural thrombus in the thoracic aorta, with visceral arterial embolism. Each underwent a successful operative thrombectomy. Both patients had a normal underlying aortic intima at inspection.
The first patient was a young male with no known diseases. He regularly used cannabis and tested positive on admission, an asso- ciation not yet reported with aortic mural thrombus. He was found to have a slightly reduced protein C.
The second patient was a middle aged man with non-insulin depen- dant diabetes, hyperlipidaemia, arterial hypertension and hyper- thyroidism. He was found to have an underlying adenocarcinoma of the lung and received chemotherapy. He died due to his cancer, 4 months after first presentation. (Acta gastroenterol. belg., 2010, 73, 55-60).
Fatal hypoxic hepatitis in a patient with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber's disease)
Hypoxic (ischemic) hepatitis generally requires the concurrence of an underlying condition which chronically exposes the liver to some degree of hypoxia (for example, congestive heart failure) combined with a triggering event (for example, arrhythmia) which further decreases the oxygen supply. We report a case of hypoxic hepatitis in which hereditary hemorrhagic telangiectasia (Rendu- Osler-Weber's disease) constituted this underlying condition and gastrointestinal hemorrhage was the triggering event. To our knowledge, this is the first reported case of hypoxic hepatitis in hereditary hemorrhagic telangiectasia with the exception of thera- peutic ligation or embolization of the hepatic artery so as to decrease shunting of liver blood. Hemodynamic mechanisms are proposed to explain this particular outcome. (Acta gastroenterol. belg., 2010, 73, 61-64).
Haemostasis monitoring during sequential aortic valve replacement and liver transplantation
Despite advances in anaesthesiological and surgical techniques, cardiac surgery in cirrhotic patients remains hazardous. This report outlines our experience with haemostasis monitoring in two consecutive cases of sequential aortic valve replacement and liver transplantation. Clotting disturbances proved to have fatal conse- quences since one of these patients died following massive lung embolism. The second patient underwent successfully this com- bined procedure and is in good clinical state 14 months postopera- tively. Evaluation and discussion of the coagulation monitoring by the Sonoclot Analyzer in both patients and related therapeutic sug- gestions for the prevention of thrombotic events are discussed. (Acta gastroenterol. belg., 2010, 73, 65-68).