Hemorragia digestiva alta por várices gástricas secundarias a trombosis de vena esplénica tratada con esplenectomía

Upper gastrointestinal bleeding secondary to acute variceal hemorrhage is a medical emergency, with significant morbidity and mortality, which usually requires a multidisciplinary approach from gastroenterologists, intensive care physicians, and surgeons. The most common cause of variceal bleeding is the one that arises from portal hypertension associated with cirrhosis, and best described in terms of prevention, initial management and following treatment that in the minority of cases can be definitive without complex interventions, including liver transplant in cirrhotic patients. Within the etiologies not arising from portal hypertension, splenic vein thrombosis is one of the most important. Characterized by an endoscopic appearance of fundal or isolated gastric varices, without esophageal involvement, a variable number of cases manifest clinically as variceal hemorrhage. Based on different pathophysiology compared to esophageal varices, response to initial treatment is different, endoscopic management involve the use of adhesives (e.g. cyanoacrylate) as treatment of choice, and, in selected cases, surgical treatment can provide a definitive solution. Here we present a clinical case of an adult patient, without history of cirrhosis, who presented to the emergency department with severe upper gastrointestinal bleeding secondary to gastric varices, admitted in Intensive Care Unit and treated with endoscopy. Complementary studies with abdominal CT showed spleen vein thrombosis, enlarged spleen and multiple varicesin gastric body and fundus. After stabilization, splenectomy was performed as definitive treatment, with regression of gastric varices on ambulatory control with an upper endoscopy...(AU) La hemorragia digestiva alta por sangrado variceal agudo constituye una emergencia medica, con morbimortalidad significativa asociada, requiriendo manejo multidisciplinario de gastroenterologos, intensivistas y cirujanos. El sangrado variceal por hipertension portal secundario a dano hepatico cronico es el mas habitual y mejor caracterizado en prevencion, enfrentamiento inicial y manejo posterior, que en la minoria de los casos puede ser definitivo, sin intervenciones complejas, incluyendo trasplante hepatico en pacientes cirroticos. Dentro de las causas de sangrado variceal no asociadas a hipertension portal, la trombosis de vena esplenica es una de las principales. Caracterizada por presentarse en endoscopia como varices gastricas fundicas o aisladas sin compromiso esofagico, se manifiestan clinicamente como sangrado variceal agudo en un porcentaje variable de casos. Por tener etiopatogenia distinta a las varices por hipertension portal, la respuesta frente a las medidas terapeuticas iniciales es distinta, el tratamiento endoscopico de eleccion es el uso de adhesivos tipo cianoacrilato, y en casos seleccionados, el enfrentamiento quirurgico puede ofrecer una solucion definitiva. Presentamos el caso de una paciente sin antecedentes de dano hepatico cronico, que se presento con hemorragia digestiva alta por sangrado de varices gastricas, con manejo inicial en unidad de paciente critico y hemostasia por via endoscopica. En estudio complementario se objetivo trombosis de la vena esplenica con esplenomegalia y multiples formaciones varicosas en fondo y cuerpo gastrico. Posterior a estabilizacion se realizo esplenectomia como manejo definitivo, logrando regresion de varices gastricas en endoscopia de control...(AU)