Doctors have removed 3 meters of small intestine containing a vascular malformation to save a patient with a rare disease.
Mr. QPT (38 years old, residing in Tran Phan commune, Dam Doi district, Ca Mau province) was on a business trip to Ho Chi Minh City when he suddenly had severe abdominal pain around the navel, had a lot of bloody stools, and was dizzy...
Medical history shows that in 2021, during the Covid-19 pandemic, Mr. T. was diagnosed with portal vein occlusion (the venous system that drains blood from the intestines to the liver) due to thrombosis and was treated with anticoagulants for 6 months. Thinking that the disease was cured, Mr. T. returned to his daily work and stopped treatment. However, in mid-December 2024, while working in Ho Chi Minh City, the above unusual symptoms appeared.
The patient was admitted to Gia Dinh People's Hospital in a state of severe anemia, low blood pressure and lethargy. Immediately, the patient was resuscitated for hemorrhagic shock and underwent imaging procedures to diagnose the cause of gastrointestinal bleeding. Abdominal CT scan results revealed chronic portal vein obstruction, cavernous sinus transformation (large dilated vascular system remodeling due to chronic obstruction) in the liver hilum. The main cause of bleeding was diffuse intestinal arteriovenous malformation and communication causing dilation of mesenteric venous branches.
Specialist Doctor 2 Vu Ngoc Son shares information about the case
After receiving an injection of a drug to reduce portal vein pressure combined with a lower gastrointestinal endoscopy to stop the bleeding on site, Mr. T's blood pressure gradually stabilized. However, the gastrointestinal bleeding recurred less than 48 hours later, and his blood pressure dropped again despite active blood transfusion to stabilize hemoglobin and correct coagulation disorders.
In that situation, specialists consulted together to come up with a comprehensive and optimal treatment strategy for the patient.
Coordination of 4 teams, surgery lasted continuously for 12 hours
On January 14, specialist 2 Vu Ngoc Son (Head of the digestive surgery team - Gia Dinh People's Hospital) said that immediately after determining that this was a very rare disease, which had only been reported in medical literature in the world with a few clinical cases, the hospital's board of directors approved the professional council and decided that the surgical plan required comprehensive coordination between surgical and endovascular intervention specialists. In fact, the open abdominal surgery combined with endovascular intervention during the surgery was carried out continuously with 4 surgical teams, lasting from 8:00 a.m. to 8:00 p.m. the same day.
During this process, the role of the Anesthesia and Resuscitation Department is very important, especially in maintaining stable blood pressure for the patient. Next, the vascular surgeon creates a bridge from the portal venous system to the vena cava to minimize the pressure of the portal venous system. Finally, the digestive surgeon removes nearly 3 meters of small intestine containing vascular malformations to ensure firm control of postoperative recurrent bleeding and reattaches the remaining part to restore intestinal circulation.
"In over 30 years of working in the medical field, this is the first rare case we have treated. The surgery lasted more than 12 hours, requiring the surgical team to work with a high level of concentration and intensity," Dr. Son confided.
Patient recovers after treatment
Rare disease
Two weeks after surgery, Mr. T. was able to eat and drink, his digestive function was almost restored to normal, he no longer had any gastrointestinal bleeding, and he was treated with stable anticoagulants. This unexpected success was due to the close coordination between specialists, a comprehensive preoperative preparation plan, and a multidisciplinary postoperative care strategy.
Specialist Doctor 2 Le Thi Kim Ly (Deputy Head of the Department of Internal Medicine and Gastroenterology - Gia Dinh People's Hospital) said that when the portal vein is blocked, blood from the intestines returns to the liver with difficulty and stagnates in the intestines, over time causing dilation and increased pressure in the portal venous system, eventually leading to many complications. This condition becomes especially serious and difficult to treat when there is a combination of intestinal arteriovenous malformations causing intestinal circulatory disorders and dangerous complications such as intestinal ulcers, gastrointestinal bleeding, etc., threatening the patient's life.
"This is a very rare clinical case that has been optimally treated at the present time. However, the patient also needs to continue long-term monitoring and periodically evaluate the effectiveness of treatment for intestinal vascular malformations combined with portal hypertension," said Dr. Ly.
Source: https://thanhnien.vn/tphcm-12-gio-can-nao-cat-3-met-ruot-cuu-nguoi-dan-ong-mac-benh-hiem-185250114161734324.htm
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