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Percorrer por autor "Currais, Pedro"

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  • Duodenal angiolipoma : a rare tumor causing recurrent upper gastrointestinal bleeding
    Publication . Vara-Luiz, Francisco; Nunes, Gonçalo; Oliveira, Carla; Mendes, Ivo; Dahlstedt-Ferreira, Catrine; Currais, Pedro; Pinto-Marques, Pedro; Fonseca, Jorge
    Duodenal angiolipoma is a rare adipocytic tumor, with non-specific symptoms precluding an early diagnosis. We present a case of a 67-year-old female admitted due to upper gastrointestinal bleeding. The upper endoscopy and endoscopic ultrasound evaluation showed a subepithelial lesion in the third portion of the duodenum. Endoscopic excision was performed using a standard polypectomy technique after endoloop placement. Histopathology was compatible with duodenal angiolipoma. The authors highlight duodenal angiolipoma as a rare adipocytic tumor potentially causing gastrointestinal bleeding, which can be safely treated with endoscopic excision.
    2023-11Contributo em revista Acesso aberto Ver mais
  • SX-ELLA Danis-stent for refractory acute esophageal variceal bleeding
    Publication . Currais, Pedro; Nunes, Gonçalo; Patita, Marta; Coimbra, Élia; Fonseca, Jorge
    The authors describe a 78-year-old male with alcoholic liver cirrhosis (Child-Pugh score 9 points, Meld-Na 16 points, without active drinking habits for several years). The patient had clinically significant portal hypertension manifested as refractory ascites managed with repeated large volume paracentesis and five bleeding episodes from esophageal varices. During these bleeding events the patient was treated with multiple sessions of band ligation and sclerotherapy. Two days after being discharged from the hospital due to the last bleeding episode he was readmitted due to hematemesis with hypotension and anemia. After clinical stabilization and blood transfusion to reach safe hemoglobin levels (hemoglobin at admission: Hb 6.7 g/dL), upper GI endoscopy was performed, showing in the distal third of the esophagus (37 cm from the incisors), an esophageal varix with cherry-red spots and a white nipple sign suggestive of a rupture point (Fig. 1a). Band ligation was initially tried, which was not successful due to marked fibrosis that prevented the cord to enter in the cap for banding. A massive variceal bleeding developed causing loss of endoscopic view and an SX-ELLA Danis-stent (25 × 135 mm, fully covered) was placed under guidewire with immediate technical and clinical success (Fig. 1b). The proximal limit of SX-ELLA Danis-stent was located at 29 cm of the incisors. The patient progressed favorably with no evidence of further blood loss and ICU admission was not needed. Given the several episodes of variceal bleeding despite endoscopic therapy and refractory ascites, 7 days after the index procedure a Transhepatic Portosystemic Shunt (TIPS) VIATORR® endoprosthesis with 7 mm was placed without complications reaching a hepatic venous pressure gradient of 11 mm Hg (from an initial 22 mm Hg) (Fig. 2). The Danis-stent was endoscopically removed using a foreign body forceps 11 days after its placement (Fig. 3). A marked reduction in the size of the esophageal varices and a whitish scarry area in the distal esophagus coincident with the previous rupture point were observed (Fig. 4). Clinical evolution was favorable with no further bleeding recurrence or hepatic encephalopathy and partial improvement of ascites. The patient was discharged and maintained follow-up on hepatology outpatient clinic.
    2023-03Contributo em revista Acesso aberto Ver mais