Várices esofágicas superiores (Downhill varices). Presentación de casos y revisión de la literatura
DOI:
https://doi.org/10.22516/25007440.381Palabras clave:
várices esofágicas superiores, Downhill varices, descripción de casos, revisión, hipertensión pulmonar (HTP)Resumen
Se describen 21 casos con hallazgo incidental de várices esofágicas superiores (Downhill varices) en endoscopia de las vías digestivas altas. Además, se detallan algunos datos relevantes de la historia clínica y de los hallazgos endoscópicos. La relación hombres/mujeres fue 1:1 y la edad promedio fue de 67,9 años. La comorbilidad más frecuente fue la enfermedad pulmonar obstructiva crónica (EPOC), seguida de las neumoconiosis, la obesidad y el síndrome de apnea-hipopnea, todas con hipertensión pulmonar (HTP) asociada. Las tres últimas causas no han sido descritas previamente en la literatura sobre várices esofágicas superiores. Ningún paciente tenía antecedente de hemorragia variceal.
Descargas
Referencias bibliográficas
Felson B, Lessure AP. “Downhill” Varices of the Esophagus. Dis Chest. 1964;46:740-6. https://doi.org/10.1378/chest.46.6.740
Ayvaz MA, Rakici H, Allescher HD. Are Downhill Varices an Overlooked Entity of Upper Gastrointestinal Bleedings? Gastroenterol Res Pract. 2018;2018:7638496. https://doi.org/10.1155/2018/7638496
Areia M, Romãozinho JM, Ferreira M, Amaro P, Freitas D. “Downhill” varices. A rare cause of esophageal hemorrhage. Rev Esp Enferm Dig. 2006;98(5):359-61. https://doi.org/10.4321/S1130-01082006000500006
Harwani YP, Kumar A, Chaudhary A, Kumar M, Choudeswari PR, Kankanala VV, et al. Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation. J Clin Exp Hepatol. 2014;4(1):63–65. https://doi.org/10.1016/j.jceh.2013.10.003
Siegel Y, Schallert E, Kuker R. Downhill esophageal varices: a prevalent complication of superior vena cava obstruction from benign and malignant causes. J Comput Assist Tomogr. 2015;39(2):149-52. https://doi.org/10.1097/RCT.0000000000000183
Subramaniam R, Madanagopalan N, Krishnan KT, Padmanabhan C. A case of anaplastic bronchogenic carcinoma with “downhill varices” of the esophagus. Dis Chest. 1967;51(5):545-9. https://doi.org/10.1378/chest.51.5.545
Shirakusa T, Iwasaki A, Okazaki M. Downhill esophageal varices caused by benign giant lymphoma. Case report and review of downhill varices cases in Japan. Scand J Thorac Cardiovasc Surg. 1988;22(2):135-8. https://doi.org/10.3109/14017438809105944
Inoue Y, Sakai S, Aoki T. Downhill oesophageal varices resulting from superior vena cava graft occlusion after resection of a thymoma. Interact Cardiovasc Thorac Surg. 2013;17(3):598–600. https://doi.org/10.1093/icvts/ivt212
Bédard EL, Deslauriers J. Bleeding “downhill” varices: a rare complication of intrathoracic goiter. Ann Thorac Surg. 2006;81(1):358-60. https://doi.org/10.1016/j.athoracsur.2004.08.020
Ibis M, Ucar E, Ertugrul I, Boyvat F, Basar O, Ataseven H, et al. Inferior thyroid artery embolization for downhill varices caused by a goiter. Gastrointest Endosc. 2007;65(3):543-5. https://doi.org/10.1016/j.gie.2006.10.005
van der Veldt AA, Hadithi M, Paul MA, van den Berg FG, Mulder CJ, Craanen ME. An unusual cause of hematemesis: Goiter. World J Gastroenterol. 2006;12(33):5412–5415. https://doi.org/10.3748/wjg.v12.i33.5412
Mönkemüller K, Poppen D, Feldmann K, Ulbricht LJ. Downhill varices resulting from giant intrathoracic goiter. Endoscopy. 2010;42 Suppl 2:E40. https://doi.org/10.1055/s-0029-1215290
Pop A, Cutler AF. Bleeding downhill esophageal varices: a complication of upper extremity hemodialysis access. Gastrointest Endosc. 1998;47(3):299-303. https://doi.org/10.1016/S0016-5107(98)70331-1
Hussein FA, Mawla N, Befeler AS, Martin KJ, Lentine KL. Formation of downhill esophageal varices as a rare but serious complication of hemodialysis access: a case report and comprehensive literature review. Clin Exp Nephrol. 2008;12(5):407-415. https://doi.org/10.1007/s10157-008-0055-4
Froilán C, Adán L, Suárez JM, Gómez S, Hernández L, Plaza R, et al. Therapeutic approach to “downhill” varices bleeding. Gastrointest Endosc. 2008;68(5):1010-2. https://doi.org/10.1016/j.gie.2008.02.041
Blam ME, Kobrin S, Siegelman ES, Scotiniotis IA. “Downhill” esophageal varices as an iatrogenic complication of upper extremity hemodialysis access. Am J Gastroenterol. 2002;97(1):216-8. https://doi.org/10.1016/S0002-9270(01)03979-X
Gessel L, Alcorn J. Variants of varices: is it all “downhill” from here? Dig Dis Sci. 2015;60(2):316-9. https://doi.org/10.1007/s10620-014-3501-z
Gebreselassie A, Awan A, Yaqoob H, Laiyemo A. Superior Vena Cava Obstruction: A Rare Cause of Recurrent Esophageal Variceal Bleeding. Cureus. 2018;10(2):e2226. https://doi.org/10.7759/cureus.2226
Gopaluni S, Warwicker P. Superior vena cava obstruction presenting with epistaxis, haemoptysis and gastro-intestinal haemorrhage in two men receiving haemodialysis with central venous catheters: two case reports. J Med Case Rep. 2009;3:6180. https://doi.org/10.1186/1752-1947-3-6180
Muthyala U, Philipneri MD, Hussein FA, Lentine KL. Recognition of downhill esophageal varices in hemodialysis patients requires a high index of clinical suspicion. Clin Exp Nephrol. 2009;13(6):677-8. https://doi.org/10.1007/s10157-009-0204-4
Ontanilla Clavijo G, Trigo Salado C, Rojas Mercedes N, Caballero Gómez JA, Rincón Gatica A, Alcívar-Vasquez JM, et al. Downhill varices: an uncommon cause of upper gastrointestinal bleeding. Rev Esp Enferm Dig. 2016;108(7):440-442. https://doi.org/10.17235/reed.2016.3697/2015
Pillai U, Roopkiranjot K, Lakshminarayan N, Balabhadrapatruni K, Gebregeorgis W, Kissner P. Downhill varices secondary to HeRO graft-related SVC syndrome. Semin Dial. 2013;26(5):E47-9. https://doi.org/10.1111/sdi.12078
Raghavapuram S, George N, Girotra M, Siddique S, Tharian B. Downhill esophageal varices: unusual cause of hematemesis. VideoGIE. 2017;2(9):231–232. https://doi.org/10.1016/j.vgie.2017.02.005
Berkowitz JC, Bhusal S, Desai D, Cerulli MA, Inamdar S. Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy. ACG Case Rep J. 2016;3(4):e102. https://doi.org/10.14309/crj.2016.75
Loudin M, Anderson S, Schlansky B. Bleeding ‘downhill’ esophageal varices associated with benign superior vena cava obstruction: case report and literature review. BMC Gastroenterol. 2016;16(1):134. https://doi.org/10.1186/s12876-016-0548-7
Nayudu SK, Dev A, Kanneganti K. “Downhill” Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding. Case Rep Gastrointest Med. 2013;2013:830796. https://doi.org/10.1155/2013/830796
Lim EJ, Stella DL, Russell DM. Torrential upper gastrointestinal bleeding from ‘downhill’ oesophageal varices complicating long term central venous access for total parenteral nutrition. Frontline Gastroenterol. 2010;1(2):118-120. https://doi.org/10.1136/fg.2010.001354
Yeung AK, Guilcher GM, deBruyn JC. Conservative Management of Downhill Esophageal Varices Secondary to Central Line-related Thrombosis After Hematopoietic Stem Cell Transplant. J Pediatr Hematol Oncol. 2015;37(7):e424-6. https://doi.org/10.1097/MPH.0000000000000373
Yasar B, Abut E. A case of mediastinal fibrosis due to radiotherapy and ‘downhill’ esophageal varices: a rare cause of upper gastrointestinal bleeding. Clin J Gastroenterol. 2015;8(2):73-6. https://doi.org/10.1007/s12328-015-0555-1
Basar N, Cagli K, Basar O, Sen N, Gurel OM, Akpinar I, et al. Upper-extremity deep vein thrombosis and downhill esophageal varices caused by long-term pacemaker implantation. Tex Heart Inst J. 2010;37(6):714–716.
Serin E, Ozer B, Gümürdülü Y, Yildirim T, Barutçu O, Boyacioglu S. A case of Castleman’s disease with “downhill” varices in the absence of superior vena cava obstruction. Endoscopy. 2002;34(2):160-2. https://doi.org/10.1055/s-2002-19840
Basaranoglu M, Ozdemir S, Celik AF, Senturk H, Akin P. A case of fibrosing mediastinitis with obstruction of superior vena cava and downhill esophageal varices: a rare cause of upper gastrointestinal hemorrhage. J Clin Gastroenterol. 1999;28(3):268-70. https://doi.org/10.1097/00004836-199904000-00021
Orikasa H, Ejiri Y, Suzuki S, Ishikawa H, Miyata M, Obara K, et al. A case of Behçet’s disease with occlusion of both caval veins and “downhill” esophageal varices. J Gastroenterol. 1994;29(4):506-10. https://doi.org/10.1007/BF02361251
Ennaifer R, B’chir Hamzaoui S, Larbi T, Romdhane H, Abdallah M, Bel Hadj N, et al. Downhill oesophageal variceal bleeding: A rare complication in Behçet’s disease-related superior vena cava syndrome. Arab J Gastroenterol. 2015;16(1):36-8. https://doi.org/10.1016/j.ajg.2015.02.003
Maton PN, Allison DJ, Chadwick VS. “Downhill” esophageal varices and occlusion of superior and inferior vena cavas due to a systemic venulitis. J Clin Gastroenterol. 1985;7(4):331-7. https://doi.org/10.1097/00004836-198508000-00013
Gómez-Aldana AJ, Gómez-Zuleta. Varices esofágicas en Downhill secundarias a trombosis de vena cava superior por déficit de factor V. Rev Gastroenterol Mex. 2017;82(2):179-180. https://doi.org/10.1016/j.rgmx.2016.04.007
Vorlop E, Zaidman J, Moss SF. Clinical challenges and images in GI. Downhill esophageal varices secondary to superior vena cava occlusion. Gastroenterology. 2008;135(6):1863, 2158. https://doi.org/10.1053/j.gastro.2008.10.069
Malloy L, Jensen M, Bishop W, Divekar A. “Downhill” esophageal varices in congenital heart disease. J Pediatr Gastroenterol Nutr. 2013;56(2):e9-11. https://doi.org/10.1097/MPG.0b013e31824b5fff
Gholam S, Ghazala S, Pokhrel B, Desai AP. A Rare Case of Downhill Esophageal Varices in the Absence of Superior Vena Cava Obstruction. Am J Gastroenterol. 2017;112(3):413. https://doi.org/10.1038/ajg.2016.489
Heller SL, Meyer JR, Russell EJ. Spinal cord venous infarction following endoscopic sclerotherapy for esophageal varices. Neurology. 1996;47(4):1081-5. https://doi.org/10.1212/WNL.47.4.1081
Nguyen LP, Sriratanaviriyakul N, Sandrock C. A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices. Case Rep Crit Care. 2016;2016:2370109. https://doi.org/10.1155/2016/2370109
Tsokos M, Bartel A, Schoel R, Rabenhorst G, Schwerk WB. [Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix]. Dtsch Med Wochenschr. 1998;123(22):691-5. https://doi.org/10.1055/s-2007-1024039
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Estadísticas de artículo | |
|---|---|
| Vistas de resúmenes | |
| Vistas de PDF | |
| Descargas de PDF | |
| Vistas de HTML | |
| Otras vistas | |
