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1/7. Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization.

    We describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.
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keywords = haematemesis
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2/7. portal vein thrombosis in a patient with hiv treated with a protease inhibitor-containing regimen.

    We report a case of an hiv seropositive female patient treated with a protease inhibitor-containing regimen who developed recurrent severe life-threathening episodes of haematemesis over time, caused by ruptured oesophageal varices as a consequence of a portal vein thrombosis. Coagulation tests revealed a protein s deficiency, an elevated homocysteinemia and a constitutional elevated plasma factor viii coagulant activity. These coagulopathies and the hiv infection are independent risk factors for developing venous thromboembolic events. The protease inhibitor treatment may have played a role in increasing the thromboembolic risk. The recurrent bleedings only stopped after invasive surgery. The invasive splenorenal shunt operation was in this case a life-saving procedure.
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keywords = haematemesis
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3/7. Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature.

    Splenic arteriovenous fistula (SAVF) accounts for an unusual but well-documented treatable cause of portal hypertension([1-4]). A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography (CT) and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.
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keywords = haematemesis
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4/7. Development of the Cruveilhier-Baumgarten syndrome after endoscopic obliteration of oesophageal varices. Report of a case.

    A patient with post-necrotic liver cirrhosis, presenting with recurrent haematemesis and melena due to oesophageal varices, received repeated endoscopic injection sclerotherapy. The Cruveilhier-Baumgarten syndrome developed 11 months after variceal obliteration. Neither rebleeding nor recurrence of varices was observed during a follow up period of 12 months after obliteration of varices.
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keywords = haematemesis
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5/7. Bleeding oesophageal varices caused by the budd-chiari syndrome treated by the Warren shunt.

    A previously healthy nonalcoholic 21-year old man was admitted to the hospital for further investigation because of previous severe haematemesis. Oesophageal varices proved to be the origin of the bleeding. The underlying cause for portal hypertension was total obstruction of the left and 70% obstruction of the right hepatic veins (chronic budd-chiari syndrome). Portal flow to the liver was almost normal due to well developed collaterals to the azygos vein and the patient's liver function was good. Distal splenorenal shunt (Warren shunt) was performed to decompress the varices. Postoperative recovery was uneventful and 10 months later the patient's general condition was excellent. Varices had disappeared and there was also improvement in his haematological status.
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keywords = haematemesis
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6/7. Myelofibrosis, splenomegaly, and portal hypertension.

    A patient with chronic myelofibrosis and massive splenomegaly developed portal hypertension with haematemesis occurring from radiologically proven oesophageal varices. Transjugular liver biopsy showed only myeloid metaplasia, and radiological evaluation of the portal vascular system was undertaken to establish a diagnosis of hyperkinetic portal hypertension as a basis for therapeutic splenectomy. The alternative and rare situation of splenic and portal vein occlusion was demonstrated and therefore removal of the spleen was not an appropriate procedure for relief of portal hypertension. The variceal bleeding was successfully controlled with injection sclerotherapy.
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keywords = haematemesis
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7/7. Bleeding oesophageal varices and hepatic dysfunction in adult polycystic kidney disease.

    A patient with adult polycystic liver and kidney disease presented with haematemesis and melaena and was found to have raised serum creatinine, aspartate transaminase, and alkaline phosphatase values; hypoalbuminaemia; and a prolonged prothrombin ratio. She also had oesophageal varices. With haemodialysis her aspartate transaminase activity fell to normal but she remained hypoalbuminaemic with a prolonged prothrombin ratio. She died after three weeks. Although hepatic cysts do occur in adult polycystic kidney disease, they have been thought not to cause major liver disease. The hepatic cysts in this patient, however, did appear to be associated with portal hypertension and impaired hepatocellular function.
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keywords = haematemesis
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