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Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report

World Journal of Hepatology 2022年第11期14卷 1977-1984页

作者： Vitoria Mikaelly da Silva Gomes Gustavo de Sousa Arantes Ferreira luise cristina torres rubim de barros Barbara Moreira Ribeiro Trindade dos Santos Lorenna Paulinelli Bahia Vieira department of General Surgery Hospital das Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 30130100Minas GeraisBrazil Instituto de Cardiologia do Distrito Federal Brasilia 70673900Distrito FederalBrazil department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and *** HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may *** are associated with disruption of microvasculature,such as in diabetic *** HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic *** SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic *** then developed jaundice,thrombocytopenia,and a marked elevation of serum *** ultrasound of the liver showed the presence of multiple irregular *** investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous *** lesions were considered highly suggestive of a primary neoplasm of the *** the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest *** results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated *** months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging *** This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.

关键词： Hepatic infarction Non-occlusive infarcts Diabetic ketoacidosis Pseudotumor of the liver Liver infarcts Case report

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Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

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World Journal of Surgical Procedures 2022年第2期12卷 13-19页

作者： luise cristina torres rubim de barros Barbara Moreira Ribeiro Trindade dos Santos Gustavo de Sousa Arantes Ferreira Vitoria Mikaelly da Silva Gomes Lorenna Paulinelli Bahia Vieira department of General Surgery Hospital de Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 31710350Minas GeraisBrazil department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70658-700Distrito FederalBrazil department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are associated with weight loss,and the most frequent clinical manifestations are nausea,vomiting,postprandial fullness,and abdominal *** of SMAS is usually conservative,consisting mainly of adequate nutritional support,but in refractory cases surgery may be necessary,with gastrojejunostomy and duodenojejunostomy being the most commonly performed *** SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion,who suffered significant weight loss after replacement of his jejunostomy *** was admitted to the hospital due to pain and abdominal distension.A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery,thus establishing the diagnosis of *** to the presence of the esophageal stricture,the patient was incapable of emesis;however,passage of a nasogastric tube for decompression was not *** the risk of gastric perforation due to distention,we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the *** Diagnosis of SMAS can be challenging in patients with esophageal stenosis,and risk of gastric perforation may preclude conservative treatment.

关键词： Superior mesenteric artery syndrome Duodenal obstruction Wilkie’s syndrome Esophageal stricture Esophageal stenosis Case report

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