Noncirrhotic Portal Hypertension due to Nodular Regenerative Hyperplasia Treated with Surgical Portacaval ShuntReportar como inadecuado




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Case Reports in MedicineVolume 2012 2012, Article ID 965304, 5 pages

Case Report

Department of General Surgery, William Beaumont Hospital, Beaumont Health System, Royal Oak, MI 48073, USA

Department of Gastroenterology, William Beaumont Hospital, Beaumont Health System, Royal Oak, MI 48073, USA

Division of Hepatobiliary and Transplant Surgery, Department of General Surgery, William Beaumont Hospital, Beaumont Health System, Royal Oak, MI 48073, USA

Received 21 May 2012; Accepted 23 July 2012

Academic Editor: Eric M. Yoshida

Copyright © 2012 Lisa M. Louwers et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nodular regenerative hyperplasia NRH is an uncommon condition, but an important cause of noncirrhotic intrahepatic portal hypertension NCIPH, characterized by micronodules of regenerative hepatocytes throughout the liver without intervening fibrous septae. Herein, we present a case of a thirty-seven-year-old female with systemic lupus erythematosus SLE who was discovered to have significant esophageal varices on endoscopy for dyspepsia. Her labs revealed a slight elevation in the alkaline phosphatase and mild thrombocytopenia. Abdominal MRI revealed seven focal hepatic masses, splenomegaly, no ascites, and a patent portal vein. Ultrasound-guided core biopsy was reported as focal nodular hyperplasia. However, her varices persisted despite treatment with beta-blockers and four additional upper endoscopies with banding. She was subsequently referred for a surgical opinion. At that time, given her history of SLE, azathioprine use, and portal hypertension, suspicion for NRH was raised. Given her normal synthetic function and lack of parenchymal liver disease, the patient was offered surgical shunting. During shunt surgery, a liver wedge biopsy was also performed and this confirmed NRH. An upper endoscopy six weeks after shunting verified complete resolution of varices. Currently, fifteen months after surgery duplex ultrasonography demonstrates shunt patency and the patient is without recurrence of her portal hypertension.





Autor: Lisa M. Louwers, Jared Bortman, Alan Koffron, Veslav Stecevic, Steven Cohn, and Vandad Raofi

Fuente: https://www.hindawi.com/



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