{"id":2573,"date":"2024-10-07T19:16:24","date_gmt":"2024-10-07T17:16:24","guid":{"rendered":"https:\/\/angh.net\/abstracts\/?p=2573"},"modified":"2024-10-07T19:16:25","modified_gmt":"2024-10-07T17:16:25","slug":"une-hemorragie-digestive-qui-a-du-ressort","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-hemorragie-digestive-qui-a-du-ressort\/","title":{"rendered":"Une h\u00e9morragie digestive qui a du ressort !"},"content":{"rendered":"

2024<\/b><\/p>\n

Manon Evain, Sandrine Barge, Mathias Vidon, Laurent Costes, Safa Hachicha, Isabelle Rosa
\nCentre hospitalier intercommunal de Cr\u00e9teil<\/em>

Gastroent\u00e9rologie <\/b> – 06\/05\/2024 – Cas clinique<\/p>\n

Il s\u2019agit d\u2019un patient de 66 ans hospitalis\u00e9 en juin 2023 pour une h\u00e9morragie digestive s\u00e9v\u00e8re avec rectorragies abondantes, h\u00e9moglobine 5,8g\/dl et instabilit\u00e9 h\u00e9modynamique n\u00e9cessitant une prise en charge en r\u00e9animation avec support vasopresseurs et transfusion de 5 CGR.
\nDans ses ant\u00e9c\u00e9dents on retrouve une AOMI non s\u00e9v\u00e8re, une dyslipid\u00e9mie et une h\u00e9patectomie droite \u00e9largie avec anastomose bilio-digestive sur une anse mont\u00e9e en Roux en Y en 2020 pour un cholangiocarcinome Bismuth IIIa, en cours de chimioth\u00e9rapie par GEMZAR CISPLATINE et DURVALUMAB \u00e0 ce moment-l\u00e0 pour une r\u00e9cidive loco r\u00e9gionale du hile h\u00e9patique.
\nL\u2019EOGD r\u00e9alis\u00e9e en r\u00e9animation retrouve des VO de grade I, une gastropathie d\u2019hypertension portale et une zone d\u2019infiltration du g\u00e9nu sup\u00e9rius sur 3 cm. Il n\u2019y a pas de trace de saignement actif.
\nLa coloscopie retrouve 3 polypes d\u2019allure festonn\u00e9e infracentim\u00e9triques.
\nIl r\u00e9cidive de fa\u00e7on majeure \u00e0 J3 et \u00e0 J10 avec la n\u00e9cessit\u00e9 de transfuser 8 CGR. Une nouvelle EOGD retrouve les m\u00eames VO de grade I, la gastropathie d\u2019hypertension portale mais pas d\u2019infiltration du genu sup\u00e9rius qui avait \u00e9t\u00e9 imput\u00e9e initialement au saignement. Une nouvelle coloscopie ne retrouve pas de l\u00e9sion autre mais une grande quantit\u00e9 de sang rouge. Une VCE est r\u00e9alis\u00e9e ne retrouve aucune l\u00e9sion du gr\u00eale mais une angiodysplasie caecale non imputable et des traces de sang rouge dans le colon droit.
\nUne nouvelle s\u00e9rie endoscopique est r\u00e9alis\u00e9e \u00e0 J20 devant une nouvelle r\u00e9cidive majeure de l\u2019h\u00e9morragie et ne retrouve rien de nouveau.
\nUn angioTDM est de nouveau r\u00e9alis\u00e9 : quel est votre diagnostic ? <\/p>\n

R\u00e9ponse :
\nScanner AP IV qui ne retrouve pas de saignement actif mais une augmentation significative de l\u2019infiltration p\u00e9ri portale avec une st\u00e9nose du tronc porte, des signes d\u2019hypertension portale avec des voies de d\u00e9rivation multiples et des m\u00e9tastases pulmonaires.
\nCavernome veineux sur l\u2019anse mont\u00e9e avec varices ectopiques de la paroi de l\u2019anse mont\u00e9e.
\nMise en place d\u2019un stent du tronc porte permettant l\u2019arr\u00eat des saignements.<\/p>\n","protected":false},"excerpt":{"rendered":"

2024 Manon Evain, Sandrine Barge, Mathias Vidon, Laurent Costes, Safa Hachicha, Isabelle Rosa Centre hospitalier intercommunal de Cr\u00e9teil Gastroent\u00e9rologie – 06\/05\/2024 – Cas clinique Il s\u2019agit d\u2019un patient de 66 ans hospitalis\u00e9 en juin 2023 pour une h\u00e9morragie digestive s\u00e9v\u00e8re avec rectorragies abondantes, h\u00e9moglobine 5,8g\/dl et instabilit\u00e9 h\u00e9modynamique n\u00e9cessitant une prise en charge en r\u00e9animation […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","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":[48],"class_list":["post-2573","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-48"],"yoast_head":"\nUne h\u00e9morragie digestive qui a du ressort ! 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