A61 COLORECTAL ANASTOMOTIC VARICES IN A PATIENT WITH PORTAL HYPERTENSION: A CASE REPORT AND REVIEW OF THE LITERATURE
Notice bibliographique
Résumé
Ectopic varices (EV) account for 5% of variceal bleeding. Anastomotic varices (AV) are a rare form of EV that have been predominantly described in small bowel. To our knowledge colorectal AV have not been described. We describe a case of colorectal AV hemorrhage in a patient with portal hypertension (PH) treated with endoscopic band ligation (EBL). To gain insight into the incidence, location and optimal treatment of AV. Case report and literature review. A 63 year old woman with alcoholic cirrhosis presented with recurrent lower GI bleeding (LGIB) 2 years following sigmoid resection and primary colorectal anastomosis for colorectal cancer. Colonoscopy demonstrated anastomotic neovascularization with prominent submucosal vessels suggestive of varices, without high risk stigmata. Her symptoms resolved without intervention. She returned 5 weeks later with recurrent LGIB; sigmoidoscopy revealed AV with stigmata of recent hemorrhage successfully managed with single EBL. The next episode of LGIB occurred over 2 years later; colonoscopy revealed AV with visible erosions treated with EBL. She attended subsequent EBL sessions until variceal extinction. After several months, she presented on 3 occasions over a 2-month period for LGIB in the context of alcohol binges. AV with erosions were visualized at each episode, however there was no active bleeding or endoscopic intervention. A PubMed and Cochrane Database of Systematic Reviews search produced publications describing varices at surgical sites, most of which were peristomal. There were 4 cases of esophagojejunal AV, 13 cases of gastroduodenal AV, and 3 cases of jejunal varices after hepatico- or choledochojejunostomy. The most distal anastomosis reported was a case series of 10 patients with PH who underwent ileal pouch-anal anastomosis; none developed pouch variceal bleeding. The lack of colonic variceal involvement, particularly of the descending and sigmoid colon, may relate to their anatomical distance from, and indirect drainage to, the portal vein, resulting in indirect transmission of venous pressure. Management of AV is controversial. Endoscopic intervention with N-butyl-2-cyanoacrylate is efficacious in small bowel AV. Transjugular intrahepatic portosystemic shunt and percutaneous transhepatic obliteration is beneficial in EV. Surgical resection or transcatheter embolization can be effective, however perioperative morbidity and mortality is high. To our knowledge, EBL for colorectal AV has not been described. This treatment modality appears to be useful for temporary hemostasis but rebleeding rates appear to be high. A case report of colorectal AV is presented. EBL achieved temporary hemostasis but rebleeding rates were high. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».