pituitrin and Mesenteric-Vascular-Occlusion

In a series of 602 consecutive sclerotherapies, two cirrhotic patients who had received successful sclerotherapy for control of variceal bleeding while on vasopressin infusions developed mesenteric thrombosis. We found no other cases (in our institution or in literature review) where sclerotherapy or vasopressin infusion alone precipitated mesenteric thrombosis. During vasopressin infusion, there is portal stasis and an increased caudad flow of sclerosant. We suggest that mesenteric thrombosis is a consequence of the combination of these two effects. Direct injection of gastric varices is difficult because of increased postsclerotherapy bleeding, but sclerosis of esophageal varices often leads to their obliteration by the caudad flow of sclerosant. We propose, therefore, that vasopressin infusion during esophageal sclerotherapy may be beneficial in the obliteration of gastric varices. We conclude that (a) in patients without gastric varices, vasopressin infusion increases the incidence of mesenteric thrombosis, and (b) vasopressin infusion during sclerotherapy may enhance the sclerosis of gastric varices.

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Portal System; Sclerosing Solutions; Thrombosis; Vasopressins

We report the occurrence of acute portal vein thrombosis in three patients undergoing endoscopic variceal sclerosis (EVS) for bleeding esophageal varices. All patients received intravenous vasopressin in close proximity to or at the time of EVS. By increasing flow of sclerosant caudally into gastric veins during EVS, vasopressin may predispose to retrograde propagation of thrombus into the portal venous system. Combined use of vasopressin and EVS for treatment of bleeding esophageal varices should be undertaken with caution.

Topics: Acute Disease; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Portal Vein; Sclerosing Solutions; Thrombosis; Vasopressins

A patient bleeding from oesophageal varices in whom injection sclerotherapy failed to control bleeding required peripheral vein vasopressin infusion for a total of five days. Three days after stopping the infusion she collapsed and died. Post mortem examination showed the cause of death to be intestinal infarction resulting from superior mesenteric and portal vein thrombosis. This complication has not previously been described in association with vasopressin infusion into peripheral veins. The duration of each infusion should be minimised and blood volume should be carefully monitored throughout. The condition should be suspected in patients who develop unexplained abdominal pain or collapse following vasopressin treatment.

Topics: Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Infarction; Infusions, Parenteral; Intestines; Mesenteric Vascular Occlusion; Mesenteric Veins; Portal Vein; Thrombosis; Vasopressins

The administration of intraaterial mesenteric vasopressin to induce small intestinal ischemia was evaluated in the cat. Small intestinal blood flow was measured by carbonized microsphere distribution and electromagnetic flowmetry. Injection of 99mTc labeled isotope into the superior mesenteric artery was monitored by gamma camera, and isotope kinetics were evaluated as indicators of small intestinal blood flow. Superior mesenteric arterial and small intestinal mucosal blood flow could maximally be reduced to 15%-20% of control by vasopressin administration. 99mTcO4 mesenteric-cardiac transit time was doubled in all animals when small intestinal mucosal blood flow was reduced to less than one-third of control. However, significant blood flow reductions were induced in other abdominal organs, most importantly in retroperitoneal lymph nodes and adipose tissue. Intraarterial mesenteric vasopressin administration does not induce sufficiently severe and specific intestinal ischemia to provide optimal conditions for selective small intestinal hypoxic radioprotection.

Topics: Animals; Blood Flow Velocity; Cats; Female; Half-Life; Infusions, Intra-Arterial; Intestine, Small; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Radiation Injuries; Radionuclide Imaging; Regional Blood Flow; Technetium; Vasopressins

Topics: Animals; Dogs; Dose-Response Relationship, Drug; Hypertension; Intestinal Mucosa; Intestines; Mesenteric Arteries; Mesenteric Vascular Occlusion; Oxygen Consumption; Regional Blood Flow; Vasopressins; Venous Pressure

Topics: Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Ileum; Infusions, Parenteral; Intestinal Diseases; Ischemia; Jejunum; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Thrombosis; Vasopressins

Topics: Catheterization; Esophageal and Gastric Varices; Gangrene; Gastrointestinal Hemorrhage; Hepatic Encephalopathy; Humans; Intestinal Diseases; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Portal Vein; Sepsis; Thrombophlebitis; Thrombosis; Vasopressins

Topics: Alcoholism; Angiography; Autopsy; Esophageal and Gastric Varices; Fatty Liver; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Infarction; Injections, Intra-Arterial; Intestine, Small; Liver Cirrhosis; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Mesenteric Veins; Thrombosis; Vasopressins