{"id":2294,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-thrombose-porte-pas-comme-les-autres\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"une-thrombose-porte-pas-comme-les-autres","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-thrombose-porte-pas-comme-les-autres\/","title":{"rendered":"Une thrombose porte pas comme les autres\u2026"},"content":{"rendered":"<p><strong>2019<\/strong><\/p>\n<p><em>F. Zuberbuhler, E. Pateu, A. Paisant, M. Kaassis, YH. Lam<br \/>\nCH Cholet<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02019-05-12 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>La hernie du foramen de Winslow est une pathologie rare, qui repr\u00e9sente 8% des hernies internes, elles-m\u00eames \u00e9tant \u00e0 l\u2019origine d\u2019une tr\u00e8s faible proportion des occlusions gr\u00ealiques. Le diagnostic est souvent fait avec retard en p\u00e9ri-op\u00e9ratoire lors de complications. Nous rapportons le cas d\u2019une pr\u00e9sentation atypique puisque le diagnostic a \u00e9t\u00e9 pos\u00e9 8 mois plus tard, \u00e0 l\u2019occasion d\u2019une relecture du scanner initial. Cette observation est l\u2019occasion de revoir l\u2019anatomie de la hernie de Winslow et d\u2019\u00e9voquer les pathologies associ\u00e9es.<\/p>\n<p>Cas clinique <\/p>\n<p>Une patiente de 68 ans, ayant pour principal ant\u00e9c\u00e9dent un syndrome d\u00e9pressif trait\u00e9 par EFFEXOR, consulte aux urgences le 16 ao\u00fbt pour \u00e9pigastralgies brutales irradiant dans l\u2019hypochondre droit associ\u00e9es \u00e0 des vomissements. Les douleurs \u00e9voluent depuis moins de 24h.<br \/>\nA l\u2019examen clinique, elle a une d\u00e9fense en \u00e9pigastre et hypochondre droit. Le reste de l\u2019examen est normal. Au bilan biologique on ne retrouve qu\u2019une hyperleucocytose mod\u00e9r\u00e9e \u00e0 13,7 G\/L, sans \u00e9l\u00e9vation de la CRP. Le bilan h\u00e9patique est normal, ainsi que la lipas\u00e9mie.<br \/>\nLe scanner abdominal r\u00e9v\u00e8le une thrombose porte avec \u0153d\u00e8me p\u00e9ri-portal et infiltration de la paroi digestive d\u2019amont. Une anticoagulation curative en IVSE est d\u00e9but\u00e9e.<br \/>\nL\u2019\u00e9volution est rapidement favorable. Au scanner du 23 ao\u00fbt, le tronc porte est perm\u00e9able. L\u2019h\u00e9parinoth\u00e9rapie est relay\u00e9e par un AVK. Le bilan de thrombophilie r\u00e9alis\u00e9 ne permet pas de mettre en \u00e9vidence un facteur pro-thrombotique. A 6 mois de l\u2019anticoagulation, le dossier de Mme W. est discut\u00e9 pour \u00e9tablir la dur\u00e9e n\u00e9cessaire du traitement. Cependant, \u00e0 la relecture du scanner du 16 ao\u00fbt, le radiologue est interpell\u00e9 par diff\u00e9rents \u00e9l\u00e9ments : un syst\u00e8me porte lamin\u00e9, \u00e9loignement de la veine porte par rapport \u00e0 la veine cave, absence du caecum en fosse iliaque droite. Le diagnostic d\u2019hernie de Winslow est pos\u00e9. <\/p>\n<p>Discussion <\/p>\n<p>Le hiatus de Winslow est un orifice faisant communiquer le vestibule de l&rsquo;arri\u00e8re cavit\u00e9 des \u00e9piploons, avec la grande cavit\u00e9 p\u00e9riton\u00e9ale.<br \/>\nLa hernie de Winslow contient le plus souvent de l\u2019intestin gr\u00eale, mais peut contenir aussi le caecum et colon ascendant et plus exceptionnellement la v\u00e9sicule biliaire et le colon transverse. Elle peut comprimer les \u00e9l\u00e9ments contenus dans le ligament h\u00e9pato-duod\u00e9nal, ce qui explique les diff\u00e9rents tableaux cliniques observ\u00e9s.<br \/>\nParmi les cas cliniques retrouv\u00e9s dans la litt\u00e9rature, les anomalies de la veine porte sont fr\u00e9quemment d\u00e9crites, \u00e0 type de r\u00e9tr\u00e9cissement du tronc porte associ\u00e9 \u00e0 un \u0153d\u00e8me p\u00e9ri-portal. Il est rapport\u00e9 deux cas cliniques o\u00f9 un diagnostic de thrombose veineuse avait initialement \u00e9t\u00e9 pos\u00e9 : l\u2019un avec une image de thrombose porte et l\u2019autre ayant des signes radiologiques \u00e9vocateurs d\u2019un syndrome de Budd Chiari.<br \/>\nLe traitement est habituellement chirurgical, et consiste en des man\u0153uvres de r\u00e9duction. Le pronostic est conditionn\u00e9 par la n\u00e9crose gr\u00ealique, parfois importante lorsque le diagnostic a \u00e9t\u00e9 tardif. Dans notre cas, une prise en charge chirurgicale n\u2019a pas \u00e9t\u00e9 n\u00e9cessaire, car la r\u00e9duction a \u00e9t\u00e9 spontan\u00e9e. A notre connaissance, tous les cas de figure pr\u00e9sent\u00e9s dans la litt\u00e9rature, ont d\u00fb \u00eatre pris en charge en urgence.<br \/>\nUne \u00e9ventuelle chirurgie pourrait \u00eatre discut\u00e9e pour limiter le risque de r\u00e9cidive : obturations du hiatus par suture directe, suture de l\u2019angle colique droit, colectomies droites\u2026 Aucune recommandation sur un \u00e9ventuel traitement prophylactique n\u2019a \u00e9t\u00e9 faite jusqu\u2019\u00e0 pr\u00e9sent. <\/p>\n<p>Conclusion <\/p>\n<p>La hernie de Winslow est une hernie interne rare, r\u00e9v\u00e9l\u00e9e le plus souvent par un tableau occlusif dont le traitement est chirurgical. Peu connue des m\u00e9decins, le diagnostic est souvent fait avec retard, ce qui conditionne le pronostic. Elle peut, comme dans notre cas, \u00eatre confondue avec une thrombose veineuse mais la connaissance des quelques signes indirects au scanner pourrait probablement permettre un diagnostic plus pr\u00e9coce.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2019 F. Zuberbuhler, E. Pateu, A. Paisant, M. Kaassis, YH. Lam CH Cholet Gastroent\u00e9rologie &#8211; \u00a02019-05-12 &#8211;\u00a0CC &#8211; ________________________________ La hernie du foramen de Winslow est une pathologie rare, qui repr\u00e9sente 8% des hernies internes, elles-m\u00eames \u00e9tant \u00e0 l\u2019origine d\u2019une tr\u00e8s faible proportion des occlusions gr\u00ealiques. Le diagnostic est souvent fait avec retard en p\u00e9ri-op\u00e9ratoire [&hellip;]<\/p>\n","protected":false},"author":1,"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":[4],"tags":[30],"class_list":["post-2294","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-30"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Une thrombose porte pas comme les autres\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-thrombose-porte-pas-comme-les-autres\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une thrombose porte pas comme les autres\u2026 - 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