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Revista da Associação Médica Brasileira
On-line version ISSN 1806-9282
ASSEF, José Cesar; CAPUA JUNIOR, Armando de and SZUTAN, Luiz Arnaldo. Treatment of recurrent hemorrhage esophageal varices in schistosomotic patients after surgery. Rev. Assoc. Med. Bras. [online]. 2003, vol.49, n.4, pp.406-412. ISSN 1806-9282. http://dx.doi.org/10.1590/S0104-42302003000400032.
OBJECTIVE: To standardize the treatment recurrent hemorrhage esophageal varices in schistosomotic patients after non decompressive surgery. METHODS: We treated 45 patients with schistosomotic portal hypertension who presented recurrent hemorrhage esophageal varices. Performance of abdominal ultra-sonography and arteriographic studies and two groups were defined: Group A: Nineteen patients (42,2%) with absence of spleen, occluded splenic artery and patency of left gastric artery and vein, thus characterizing splenectomy at prior operation. Group B: Twenty six patients (57,8%) with absence of spleen image, occluded splenic and left gastric artery and non-opacified left gastric vein, showing splenectomy and some type of gastroesophageal devascularization performed before. Patients of Group A were reoperated to carry out the gastroesophageal devascularization and patients of Group B were submitted to a sclerotherapy program. RESULTS: In Group A, one patient (5.3%) presented recurrent hemorrhage on the late postoperative period. The esophageal varices decreased in number or diameter in 14 patients (73.7%), disappeared in three (15.8%) and remained unchanged in two (10.5%), under final endoscopic evaluation. In Group B, six patients (23.1%) presented recurrent bleeding. In four patients the acute hemorrhagic event were controlled. Two patients who underwent mesocaval shunt owing to unsuccess of these methods died postoperatively. Esophageal varices disappeared in 17 patients (65.4%), decreased in number or diameter in seven (26.9%) and remained unchanged in two (7.7%) after the last endoscopic evaluation. CONCLUSIONS: 1) The gastroesophageal devascularization is appropriated to splenectomized patients, with patency of left gastric artery and vein. 2) A long term of esophageal varices endoscopic sclerotherapy may be an option to splenectomized patients, with occluded left gastric artery and non-opacified left gastric ven.
Keywords : Schistosomiasis; Portal hypertension; Esophageal varices.