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T R ATA M E N T U L E N D O S C O P I C A L U N U I U L C E R
D I E U L A F O Y I L E A L C U H E M AT O C H E Z I E M A S I V Ă
C U A J U TO R U L E N T E R O S C O P I E I S P I R A L E
Pacient, 26 ani

 APP
   hemofilie tip A de la 3 ani

   2009 un episod de HDI remis spontan



 Obiectiv:
   tegumente palide

   TA=90/50mmHg, AV=100bpm

   scaune melenice alternativ cu hematochezie

   varsaturi alimentare fara elemente hematice
Pacient, 26 ani

 Biologic:
   Ht=14,7%
   Hgb=3,64 mg/dl
   Fier=30 microg/dl



 EDS:
   Esofag normal.
   Stomac cu corpul gastric, antru normal.
   Bulb, D2 libere.
   Concluzie: nu se deceleaza sursa de sangerare



 EDI:
   Cecul si valva ileocecala normale.
   La retragere nu se deceleaza leziuni.
   Canal anal cu dilatatii hemoroidale.
Diagnostic de etapa



 Hemoragie   digestiva inferioara - melena
 Sindrom anemic sever

 Hemofilie tip A
Suprafata interna
                                                                                                    • suprafata interna neteda scade
                                                                                                    frecarea la interfata cu enteroscopul
                                                                                                    daca este corespunzator lubrefiata
Compatibilitate
 Discovery SB este compatibil
cu enteroscoape de:
• 200cm lungime
• 9.1mm–9.5mm diametru

                                                                                             Manere ergonomice
                                                                                             • buretele asigura o
                 Dispozitiv de blocare                                                        manevrabilitate crescuta.

                  • conecteaza Discovery SB cu
                 enteroscopul.
                 • se cupleaza/decupleaza usor
                 si rapid de enteroscop                                                                  Tubul flexibil
                 • nu distruge enteroscopul.                                                             • in portiunea proximala este mai
                                                                                                         rigid decat in cea distala, asemanator
                                                                                                         endoscoapelor flexibile
                                                                                                         • prin lumenul sau avanseaza
                                                                                                         enteroscopul
                                                                              Discovery SB spirals
                                                                      • portiunea moale a spiralei faciliteaza
                                                                      depasirea ligamentului Treitz.
                                Zona de tranzitie
                                                                      • prin rotire aduna si pliaza intestinul
                                • capatul distal tesit siliconat      subtire cu mentinerea pozitiei
10/28/2011                      ermetizeaza si faciliteaza trecerea   • disponibila in doua variante
                                 intre spirala si enteroscop.
Enteroscopie spirala




                             Avansare enteroscop




   Retroviziune cu spirala




                              Stomac
ES ileon mediu   HDI cec
Concluzii


Primul caz de ulcer Dieulafoy ileal la un pacient
adult diagnosticat si tratat cu ajutorul
enteroscopiei spirale.

Daca etiologia unei OGIB ramane neelucidata in
ciuda tehnicilor standard de diagnostic
endoscopic, noi tehnici precum enteroscopia
spirala pot contribui la decelarea acesteia.

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Prezentare enteroscopie 2010

  • 1. T R ATA M E N T U L E N D O S C O P I C A L U N U I U L C E R D I E U L A F O Y I L E A L C U H E M AT O C H E Z I E M A S I V Ă C U A J U TO R U L E N T E R O S C O P I E I S P I R A L E
  • 2. Pacient, 26 ani  APP  hemofilie tip A de la 3 ani  2009 un episod de HDI remis spontan  Obiectiv:  tegumente palide  TA=90/50mmHg, AV=100bpm  scaune melenice alternativ cu hematochezie  varsaturi alimentare fara elemente hematice
  • 3. Pacient, 26 ani  Biologic:  Ht=14,7%  Hgb=3,64 mg/dl  Fier=30 microg/dl  EDS:  Esofag normal.  Stomac cu corpul gastric, antru normal.  Bulb, D2 libere.  Concluzie: nu se deceleaza sursa de sangerare  EDI:  Cecul si valva ileocecala normale.  La retragere nu se deceleaza leziuni.  Canal anal cu dilatatii hemoroidale.
  • 4. Diagnostic de etapa  Hemoragie digestiva inferioara - melena  Sindrom anemic sever  Hemofilie tip A
  • 5. Suprafata interna • suprafata interna neteda scade frecarea la interfata cu enteroscopul daca este corespunzator lubrefiata Compatibilitate Discovery SB este compatibil cu enteroscoape de: • 200cm lungime • 9.1mm–9.5mm diametru Manere ergonomice • buretele asigura o Dispozitiv de blocare manevrabilitate crescuta. • conecteaza Discovery SB cu enteroscopul. • se cupleaza/decupleaza usor si rapid de enteroscop Tubul flexibil • nu distruge enteroscopul. • in portiunea proximala este mai rigid decat in cea distala, asemanator endoscoapelor flexibile • prin lumenul sau avanseaza enteroscopul Discovery SB spirals • portiunea moale a spiralei faciliteaza depasirea ligamentului Treitz. Zona de tranzitie • prin rotire aduna si pliaza intestinul • capatul distal tesit siliconat subtire cu mentinerea pozitiei 10/28/2011 ermetizeaza si faciliteaza trecerea • disponibila in doua variante intre spirala si enteroscop.
  • 6.
  • 7. Enteroscopie spirala Avansare enteroscop Retroviziune cu spirala Stomac
  • 8. ES ileon mediu HDI cec
  • 9.
  • 10. Concluzii Primul caz de ulcer Dieulafoy ileal la un pacient adult diagnosticat si tratat cu ajutorul enteroscopiei spirale. Daca etiologia unei OGIB ramane neelucidata in ciuda tehnicilor standard de diagnostic endoscopic, noi tehnici precum enteroscopia spirala pot contribui la decelarea acesteia.

Editor's Notes

  1. Existamaimulteindicatii ale explorariiendoscopice a intestinuluisubtire, recomandareaceamaifrecventafiindsangerareaocultagastrointestinala (OGIB). Pacienţii cu OGIB suntdificil de diagnosticat, iargestionareatratamentullorpoatefi o provocare.
  2. Prezentamcazulunuipacient de 26 ani, cunoscut cu hemofilie tip A, care s-a internat in serviciulnostrupentruhemoragiedigestivainferioaraexteriorizataprinhematocheziemasivasimelenasisindrom anemic sever (Hgb=4mg/dl).
  3. Esogastroduodenoscopiasicolonoscopia nu au decelatleziunisausurse de sangerare
  4. S-au utilizatenteroscopul single balloon Olympus sidispozitivul Discovery SB (DBS) de 118 cm lungimesi 48 French diametru, cu un element helicoidalelevat la capatul distal de 21 cm lungime.
  5. SB spiral through the esophagus during both initial insertion and withdrawal. This will minimize any“sandwiching” of tissue between the balloon and Discovery SB.
  6. Avansarea de-a lungulintestinuluisubtire s-a realizatprinrotatia DBS peenteroscop in sensulacelor de ceasornic, rotatie care pliazaastfelintestinul. La examinareaanterograda a intestinuluisubtire nu s-a decelatnici o leziune care saexplicesindromul anemic, sub rezervaprogresieipana in ileonulmediu.
  7. S-a decisefectuareaenteroscopiei retrograde; la nivelulcecului s-a evidentiatsangeproaspat
  8. La nivelulileonului distal, la aproximativ 40 cm de valvaileo-cecala s-a evidentiat un ulcer cu vas arterial vizibil in crater sisangerareactiva. S-a efectuattratament endoscopic prinmontare de clipuri. Sangerarea a fostoprita cu evolutiefavorabila a pacientuluisiexternare la douazile. Pacientul nu a prezentatacuzesubiectivedupainterventie (data fiindduratalunga a examinarii- necesitateaefectuariiatat a enteroscopieianterograde cat si retrograde pentrudecelareasursei de sangerare).