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UNIVERSIDAD PRIVADA SAN JUAN BAUTISTA

FACULTAD DE CIENCIAS DE LA SALUD


ESCUELA PROFESIONAL DE MEDICINA HUMANA

INVESTIGACIN FORMATIVA
CASOS CLINICOS ANGIOLOGIA Y CIRUGIA VASCULAR

CURSO: INGLES

DOCENTE: ANYOSA ORE MASSIEL WENDY

ALUMNOS: ALEGRIA CANALES ELIZABETH CLAUDIA


AGUILAR GERONIMO JHONATAN JUSTO
CICLO: V

SEMESTRE: 2017- I

ICA PER

2017
I. TTULO

ANEURISMA TROMBOSADO DE LA VENA MESENTRICA SUPERIOR

II. INTRODUCCIN

Los aneurismas venosos del sistema portal y mesentrico son muy raros; aunque los
ms infrecuentes de todos son los aneurismas de la vena mesentrica superior
(VMS). Se presenta el caso clnico de un hombre con aneurisma de vena mesentrica
superior (VMS) siendo de inters dada su escasa frecuencia y localizacin.

III. CASO CLNICO:

Hombre de 56 aos, 76 kg de peso y 174 cm de altura (ndice Masa Corporal 25,1),


operado en 2006 de tumor del estroma gastrointestinal (GIST) y en tratamiento con
rabeprazol. Acude al Servicio de Urgencias por presentar cuadro de dolor abdominal
difuso en epigastrio de 1 semana de evolucin exacerbndose en las ltimas 24
horas. En la exploracin fsica no aparecen hallazgos significativos. En la analtica
de sangre se detecta niveles de ALT/GPT 80 U/L, GGT 91 U/L, Bilirrubina total 1,62
mg/dL, Colesterol total 254 mg/dL y Protena C Reactiva 9,39 mg/L, el resto normal.

Se realiza ecografa abdominal doppler donde se visualiza una lesin hipoecognica


ovalada adyacente a la cabeza del pncreas compatible con aneurisma de la VMS.

El AngioTC de abdomen evidencia una dilatacin aneurismtica de morfologa


fusiforme de 6x4x3,5 cm localizada en la vena mesentrica superior (VMS) en la
confluencia portal. Se visualiza un trombo casi en la prctica totalidad de la misma
que se extiende a la vena esplnica, porta, rama portal derecha heptica y vena
gstrica. Acompaado de trastorno de la perfusin heptica y formacin de vasos
colaterales periportales.

En la AngioRM se aprecia una dilatacin aneurismtica con trombo intraluminal en


la vena mesentrica superior (VMS), esplnica y porta.
IV. DISCUSIN:

El aneurisma de la vena mesentrica superior (VMS) es una patologa vascular muy


poco frecuente. Afecta predominantemente a mujeres de entre 31 y 81 aos.
Generalmente esta se detecta en pacientes asintomticos, aunque en uno de cada
cuatro pacientes puede aparecer dolor abdominal recurrente en epigastrio
acompaado de nuseas y vmitos.

La etiopatogenia no es bien conocida aunque apunta a dos causas principales: un


origen congnito por un desarrollo anmalo del sistema venoso portal y un origen
adquirido relacionado con pancreatitis necrosante, fstulas traumticas o
arteriovenosas e hipertensin portal.

El diagnstico diferencial se debe realizar con tumores pancreticos y duodenales,


aneurismas arteriales y cualquier otra lesin slida. El diagnstico definitivo se
establece mediante las pruebas de imagen como la ecografa doppler, el AngioTC
y/o AngioRM.

V. LISTA DE ABREVIATURAS:

VMS: Vena Mesentrica Superior.

GIST: Tumor del estroma gastrointestinal (gastrointestinal stromal tumors)

ALT/GPT: Alaninoaminotransferasa.

GGT: Gamma Glutamil Transferasa.

AST/GOT: Aspartatoaminotransferasa.

GIST: Tumor del estroma gastrointestinal.


I. TITLE

TUMBLE ANEURISM OF THE SUPERIOR MESENTERIC VEIN

II. INTRODUCTION

Venous and mesenteric venous aneurysms are very rare; Although the most
uncommon of all are the superior mesenteric vein aneurysms (VMS). We report the
case of a man with superior mesenteric vein aneurysm (VMS) being of interest given
its low frequency and location.

III. CLINICAL CASE:

A man of 56 year old, with 76 kg in weight and 174 cm in height (Body Mass Index
25.1), operated in 2006 of gastrointestinal stromal tumor (GIST) and with
treatment of rabeprazole. He went to the emergency room because he presented
diffuse abdominal pain in the epigastrium of 1 week of evolution, exacerbating in
the last 24 hours. There are no significant findings on physical examination. In the
blood analysis, levels of ALT/GPT 80 U/L, GGT 91 U/L, total bilirubin 1.62
mg/dL, total cholesterol 254 mg/dl and C-reactive protein 9.39 mg/L were detected.
Rest normal.

Abdominal Doppler ultrasound is performed when an oval hypoechogenic lesion is


visualized adjacent to the pancreas head compatible with the VMS aneurysm.

Abdomen AngioTC shows aneurysmal dilatation of fusiform morphology of


6x4x3,5 cm located in the superior mesenteric vein (VMS) at portal confluence. A
thrombus is seen almost in the whole of the same that extends to the splenic vein,
portal, hepatic right portal branch and gastric vein. Accompanied by hepatic
perfusion disorder and formation of periportal collateral vessels.

AngioMR shows aneurysmal dilation with intraluminal thrombus in the superior


mesenteric (VMS), splenic and portal vein.
IV. DISCUSSION:

Superior mesenteric vein aneurysm (VMS) is a very rare vascular pathology. It affects
predominantly women between 31 and 81 years. Usually this is detected in
asymptomatic patients, although recurrent abdominal pain in the epigastrium
accompanied by nausea and vomiting may occur in one in four patients.

The etiopathogenesis is not well known although it points to two main causes: a
congenital origin due to anomalous development of the portal venous system and an
acquired origin related to necrotizing pancreatitis, traumatic or arteriovenous fistulas
and portal hypertension.

The differential diagnosis should be made with pancreatic and duodenal tumors, arterial
aneurysms and any other solid lesions. The definitive diagnosis is established by
imaging tests such as Doppler ultrasound, AngioTC and / or AngioRM.

V. LIST OF ABBREVIATIONS:

VMS: Superior Mesenteric Vein.

GIST: Gastrointestinal stromal tumor (gastrointestinal stromal tumors)

ALT / GPT: Alaninoaminotransferase.

GGT: Gamma Glutamyl Transferase.

AST / GOT: Aspartate aminotransferase.

GIST: Gastrointestinal stromal tumor.


BIBLIOGRAPHY

1. Martnez M. P. Areas of Critical Patients and Post-anesthesia. Medical


Journal.2017, Madrid. Spain.