Caracterização da Hemorragia Digestiva Aguda Severa por Angiodisplasia

 

S. Sousa Fernandes¹, M. Ferreira¹, J. M. Romãozinho¹, M. Ferreira¹, P. Amaro¹, M. Correia Leitão¹

 

 

RESUMO

INTRODUÇÃO: As angiodisplasias são causas raras de hemorragia digestiva aguda. A natureza intermitente da hemorragia e a extensão de tubo digestivo envolvido colocam desafios particulares. OBJECTIVOS: Caracterizar  as hemorragias digestivas agudas severas por angiodisplasia. DOENTES E MÉTODOS: Análise retrospectiva das hemorragias digestivas agudas por angiodisplasia  admitidas na Unidade de Cuidados Intensivos de Gastrenterologia (UCIGE) dos Hospitais da Universidade de Coimbra, entre 1992 e 2008. RESULTADOS:  Incluídos 21 doentes, representando 0,54% das admissões no período considerado. Registou-se predomínio do sexo masculino e idade média de 74 anos (42-92). Todos os doentes apresentavam co-morbilidades e 40% tomavam antiagregantes plaquetares ou anticoagulantes. A hemorragia foi proximal à ampola de Vater em 62% dos casos. Efectuou-se hemostase endoscópica em 18 doentes, que foi eficaz em todos eles. Outras terapêuticas menos utilizadas incluíram a embolização e enterectomia. Não ocorreu recidiva hemorrágica durante os internamentos. A mortalidade cifrou-se em 4,7%, correspondendo a um doente sujeito a laparotomia, falecido no pós-operatório imediato. CONCLUSÕES: A hemorragia digestiva aguda severa por angiodisplasia foi um evento raro na UCIGE. A endoscopia teve um papel fundamental no diagnóstico e na terapêutica. Os resultados corroboram a pertinência da admissão destes casos numa UCIGE, tendo em conta, nomeadamente, a importante comorbilidade que os caracteriza.

 

 

SUMMARY

INTRODUCTION: Angiodysplasias are rare causes of acute gastrointestinal bleeding. Brisk bleeding and extension of the bowel involved are associated with specific challenges. AIM: Descrption of the main features of gastrointestinal bleeding caused by angiodysplasia. PATIENTS AND METHODS: Retrospective analysis of gastrointestinal bleeding episodes caused by angiodysplasia in patients admitted to the Gastroenterology Intensive Care Unit of Hospitais da Universidade de Coimbra, between 1992 and 2008. RESULTS: Twenty-one patients were included, representing 0,54% of all admissions in the unit during the mentioned period. Most patients were men with an average age of 74 years (42-92). All patients had comorbidities; 40% were taking antiplatelet or anticoagulant drugs. Bleeding was proximal to the ampulla of Vater in 62% of the patients. Endoscopic hemostasis was performed and was successful in 18 patients. Other therapies rarely used were angiographic embolization and segmental enterectomy. There was no recurrent bleeding during hospital stay. CONCLUSIONS: Severe gastrointestinal bleeding caused by angiodysplasia was a rare event in the unit. Endoscopy had a major role both in diagnosis and therapy. The results underline the importance of criterious admission in the Gastroenterology Intensive Care Unit, attending to the comorbidities that characterize these patients.

 

 

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¹Unidade de Cuidados Intensivos de Gastrenterologia, Hospitais da Universidade de Coimbra, Portugal

 

Correspondência:

Sónia Sousa Fernandes

Serviço de Gastrenterologia e Hepatologia do Centro Hospitalar de Vila Nova de Gaia

Rua Conceição Fernandes

4432-502 Vila Nova de Gaia, Portugal

Telefone: 227 865 100

Fax: 227 836 583

Email: sonia.sousa.fernandes@gmail.com

Recebido para publicação: 22/10/2008

Aceite para publicação: 21/04/2009