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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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.

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. The pre-lengthening citrulline level increased from In addition, he was diagnosed with type 1 diabetes at the age of 4 and had already developed incipient nephropathy in the form hiperespleniismo microalbuminuria.

Its application in adults has been reported in the literature 3. An iterative mid-line incision was made under general anesthesia. Hypoglycemia during the PN-free period necessitated I. Duodenal lengthening in short bowel with dilated duodenum. The end result is the creation of a channel of bowel approximately twice the length and half secundaril diameter of the original segment.

Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report

Megaduodenum facilitates pyloric incompetence with alkaline reflux and dysmotility with stasis of intraluminal contents which may result in bacterial overgrowth and malabsorption. This procedure is reserved for cases with life-threatening complications from TPN. 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 Written informed consent was obtained from the patient prior to the procedure.


A gastrostomy tube was left in place to facilitate drainage of gastric and bilio-pancreatic secretions. The most critical surgical issue hiperespldnismo the prevention of damage to the biliary and pancreatic ducts. Intestinal transplant registry report: To date, there are no reported experiences of duodenal lengthening in adults. J Pediatr Gastroenterol Nutr ;58 4: A radiologic gastrointestinal contrast study on the 7th postoperative day ruled out stricture or leakage before the initiation of enteral nutrition Fig.

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At 12 months post-surgery, citrulline plasma level had increased to The liver dysfunction was resolved via optimization of the parenteral formula. The classical standard duodenal tapering technique reduces the luminal diameter of the dilated duodenum by hiperdsplenismo its anti-pancreatic border longitudinally, usually with stapler devices 8.

Antibiotics were administered postoperatively for 3 days.

A Jackson-Pratt drain was placed to detect postoperative leakage. Therefore, the overall time of parenteral nutrition PN and I. The colonic mucous fistula was taken down and stapled with the construction of an end-to-side duodeno-colonic anastomosis. Due to the clinical scenario, the patient was placed on the intestinal transplant list combined with pancreas and kidney allografts. The final duodenal length was 83 cm. The length of the retained duodenum measured from the pylorus was 30 cm.


Nevertheless, the use of intestinal transplantation has declined in recent hiperesplenissmo due to the associated high morbidity and mortality that lead to poorer survival than that seen in patients on home PN 5 6. The time required on a parenteral pump has shortened from the entire day to only 9 hours at night.


Comparison of intestinal lengthening procedures for patients with short bowel syndrome. In addition, the plasma citrulline level was Despite meticulous insulin dosage management, the control of blood glycemia levels was extremely complex with frequent episodes of hypo-hyperglycemia.

A Kocher maneuver was performed to mobilize the duodenum. J Am Coll Surg ; Moreover, a colonic mucous fistula was created at the level of the transverse colon hepatic flexure. 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.

One question arises regarding the role of this surgical technique in the adaptation process. The procedure was repeated approximately every cm until the duodeno-colonic anastomosis was reached.