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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Intestinal transplant registry report: The most critical surgical issue is the prevention of damage to the biliary and pancreatic ducts.

He also follows an oral low-fiber diet ad libitum. Serum liver function test was as follows: Upper gastrointestinal series one week after duodenal lengthening and a duodeno-colic anastomosis.


The length of the retained duodenum measured from the pylorus was 30 cm. One question arises regarding the role of this surgical technique in the adaptation process. Ann Nutr Metab ; Sechndario 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night.

A Jackson-Pratt drain was placed to detect postoperative leakage. Megaduodenum facilitates pyloric incompetence with alkaline reflux and dysmotility with stasis of intraluminal contents which may result in bacterial overgrowth and malabsorption.

Surgical treatment at the time of the intestinal catastrophe consisted of the removal of the fourth part of the duodenum, the whole jejunum, ileon and ascending colon.

Am J Transplant ;15 1: The gastrostomy tube output ranged from 2. J Pediatr Gastroenterol Nutr ;58 4: Only a megaduodenum stump that reached as far as the third portion 30 cm of length and the colon up to the hepatic flexure in the form of a mucous fistula was retained.


A gastrostomy tube drained gastric and bilio-pancreatic secretions output range: In the present case, the pre-lengthening citrulline level had increased from Duodenal lengthening may be effective as part of the autologous intestinal reconstruction armamentarium in adults with short bowel syndrome. However, the benefit of the procedure in the present case was questionable due to a complete absence of the small bowel and the presence of an incomplete megaduodenum.

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 In addition, he was diagnosed with type 1 diabetes at the age of 4 and had already developed incipient nephropathy in the form of microalbuminuria.

Alteraciones del bazo (esplenectomía) by Jean Carlo Rodriguez Vasquez on Prezi

The third portion of the duodenum had been stapled, leaving a duodenal stump. At 12 months post-surgery, citrulline plasma level had increased to We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum.

Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Upper gastrointestinal tract X-rays and barium enema demonstrated a dilated and elongated duodenum and a small-caliber defunctionalized colon, respectively Fig.

The next firing was similar from the opposite side, creating a duodenal channel 3 cm in diameter.


This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Comparison of intestinal lengthening procedures for patients with short bowel syndrome.

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The main advantage of this new technique is that an additional intestinal absorptive surface is obtained without the need to discard any duodenal portion. Hypoglycemia during the PN-free period necessitated I.

Duodenal lengthening in short bowel with dilated duodenum.

Nevertheless, due to our prior successful experience with duodenal lengthening procedures in children 4the patient asked to be considered for duodenal lengthening. Long-term follow-up of patients on home parenteral nutrition in Europe: Similarly, the improvement in quality of life was questionable as the high gastrostomy output could result in a significant postoperative diarrhea following the establishment of the continuity of the intestinal tract.

He is on a PN support volume of 1, ml and ml of I. The serial transverse enteroplasty procedure STEP is an intestinal lengthening procedure originally applied in pediatric patients with short bowel syndrome SBS and dilatation of the remnant small bowel.

We have demonstrated the feasibility of lengthening the duodenum via a modified version of the original STEP in a subset of children with SBS hileresplenismo a dilated duodenum 4.