{"id":1853,"date":"2007-10-01T01:00:00","date_gmt":"2007-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-hypertension-portale-peut-en-cacher-une-autre\/"},"modified":"2018-10-20T18:39:48","modified_gmt":"2018-10-20T16:39:48","slug":"une-hypertension-portale-peut-en-cacher-une-autre","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-hypertension-portale-peut-en-cacher-une-autre\/","title":{"rendered":"UNE HYPERTENSION PORTALE PEUT EN CACHER UNE AUTRE\u2026"},"content":{"rendered":"<p><strong>2007<\/strong><\/p>\n<p><em>A Fleury, S Monat, B Benchaa, P Hervio, O Danne<br \/>\nService de Gastro-Ent\u00e9rologie, H\u00f4pital Ren\u00e9 Dubos, Pontoise<\/em><\/p>\n<p><strong>Endoscopie <\/strong>&#8211; \u00a02007-09-01 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Les anomalies endoscopiques muqueuses gastriques et coliques au cours de l\u2019hypertension<br \/>\nportale sont bien connues. En revanche, les l\u00e9sions de la muqueuse de l\u2019intestin gr\u00eale sont moins<br \/>\nbien document\u00e9es. Nous rapportons l\u2019observation d\u2019une patiente souffrant d\u2019une cirrhose<br \/>\nm\u00e9tabolique avec une an\u00e9mie chronique par carence martiale, imputable \u00e0 des ectasies<br \/>\nvasculaires antrales (EVA). Cette an\u00e9mie \u00e9tait r\u00e9cidivante malgr\u00e9 un traitement appropri\u00e9<br \/>\nassociant coagulation endoscopique au plasma argon et traitement substitutif par fer.<br \/>\nL\u2019exploration vid\u00e9o de l\u2019intestin gr\u00eale par la capsule (Pillcam SB Given Imaging) a \u00e9t\u00e9 d\u00e9cisive<br \/>\npour porter le diagnostic d\u2019ent\u00e9ropathie d\u2019hypertension portale.<br \/>\nUne patiente \u00e2g\u00e9e de 75 ans, aux ant\u00e9c\u00e9dents d\u2019hypertension art\u00e9rielle trait\u00e9e, de cancer du<br \/>\nsein gauche trait\u00e9 en 2000 par l\u2019association chirurgie et radioth\u00e9rapie \u00e9tait explor\u00e9e pour bilan<br \/>\nd\u2019une an\u00e9mie microcytaire (Hb : 7,5g\/dl), ferriprive (fer s\u00e9rique : 5,3 \u00b5mol\/l, ferritine : 10\u00b5g\/l,<br \/>\ncoefficient de saturation de la transferrine \u00e0 10%). L\u2019interrogatoire ne retrouvait ni prise de<br \/>\ntraitement gastrotoxique (AINS et aspirine), ni prise d\u2019anticoagulant ou antiagr\u00e9gant<br \/>\nplaquettaire, ni consommation d\u2019alcool. Il n\u2019existait pas de notion d\u2019h\u00e9morragie ext\u00e9rioris\u00e9e.<br \/>\nL\u2019examen clinique \u00e9tait normal hormis une p\u00e2leur cutan\u00e9omuqueuse et une ob\u00e9sit\u00e9.<br \/>\nL\u2019endoscopie gastroduod\u00e9nale retrouvait deux cordons variqueux oesophagiens grade II. L\u2019antre<br \/>\n\u00e9tait le si\u00e8ge d\u2019ectasies vasculaires r\u00e9alisant le \u00ab Water-melon stomach \u00bb. Les biopsies<br \/>\nduod\u00e9nales \u00e9taient normales. L\u2019\u00e9chographie abdominale retrouvait un foie st\u00e9atosique et<br \/>\ncirrhotique et des signes \u00e9chographiques d\u2019hypertension portale. Sur le plan biologique, \u00e9tait<br \/>\nnot\u00e9 une cholestase anict\u00e9rique (phosphatases alcalines : 1,5 N, GGT : 9N), une cytolyse (ASAT :<br \/>\n3N, ALAT : 3N), un bloc b\u00e9ta-gamma \u00e0 l\u2019\u00e9lectrophor\u00e8se des prot\u00e9ines plasmatiques. L\u2019enqu\u00eate<br \/>\n\u00e9tiologique retrouvait des arguments pour une cirrhose m\u00e9tabolique devant l\u2019association HTA,<br \/>\nob\u00e9sit\u00e9, hypercholest\u00e9rol\u00e9mie et l\u2019absence d\u2019autres causes (virale, toxique, auto-immune\u2026). A<br \/>\ncette \u00e9tape, r\u00e9v\u00e9l\u00e9 par une an\u00e9mie ferriprive, le diagnostic de cirrhose m\u00e9tabolique compliqu\u00e9e<br \/>\nd\u2019EVA \u00e9tait envisageable. Un traitement endoscopique par coagulation au plasma argon des EVA<br \/>\n(sonde Erbe, puissance : 40 W, d\u00e9bit : 1L) et un traitement martial \u00e9taient conjointement<br \/>\nentrepris. Devant la persistance de l\u2019an\u00e9mie, une coloscopie sans il\u00e9oscopie \u00e9tait pratiqu\u00e9e, ne<br \/>\nmettant pas en \u00e9vidence de l\u00e9sions coliques mais un liquide intestinal rouge\u00e2tre provenant de<br \/>\nl\u2019intestin gr\u00eale. La VCE montrait de multiples l\u00e9sions purpuriques sans anomalies de relief de la<br \/>\nmuqueuse avec conservation des villosit\u00e9s (red spot, t\u00e9langiectasies, l\u00e9sions angiomateuses)<br \/>\npr\u00e9dominant au niveau j\u00e9junal et prenant un caract\u00e8re confluent au niveau de l\u2019il\u00e9on distal.<br \/>\n(1) Dans cette observation, l\u2019exploration de l\u2019intestin gr\u00eale par la VCE a permis de visualiser<br \/>\ndes l\u00e9sions purpuriques diffuses rentrant dans le cadre d\u2019une entit\u00e9 r\u00e9cemment d\u00e9crite<br \/>\ndans la litt\u00e9rature celle d\u2019ent\u00e9ropathie d\u2019hypertension portale.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2007 A Fleury, S Monat, B Benchaa, P Hervio, O Danne Service de Gastro-Ent\u00e9rologie, H\u00f4pital Ren\u00e9 Dubos, Pontoise Endoscopie &#8211; \u00a02007-09-01 &#8211;\u00a0CO &#8211; ________________________________ Les anomalies endoscopiques muqueuses gastriques et coliques au cours de l\u2019hypertension portale sont bien connues. En revanche, les l\u00e9sions de la muqueuse de l\u2019intestin gr\u00eale sont moins bien document\u00e9es. Nous rapportons [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[18],"class_list":["post-1853","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-18"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UNE HYPERTENSION PORTALE PEUT EN CACHER UNE AUTRE\u2026 - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/une-hypertension-portale-peut-en-cacher-une-autre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UNE HYPERTENSION PORTALE PEUT EN CACHER UNE AUTRE\u2026 - 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