HAEMORRHAGE EMERGENCY FROM OESOGASTRIC VARICES IN PATIENT WITH PORTAL HIGH BLOOD PRESSURE

Abstract

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality wich sways from 30 to 50%.

High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons:

– numerous causes of bleeding;

– hepatic failure;

– the manigold possible therapies.

Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, wich endangers the patient’s life.

Our experience shows a casuistry re f e r red to the period of time wich goes from 1987 to 1998 and that comprehends 143 examined patients: 91 of them have been submitted to medical tre a t m e n t (endoscopic sclero t h e ra py, glupressin e/o somatostatin); in 52 cases it has been possible to re a l i ze a surgical treatment, different fro m the elective thera py (33 pz) and emergency thera py.

Immediate hemostatic effect obteined in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascolarization.

As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis wich, either in our very brief experience (3 cases) or by international literature, seems to offer encorauging results.