Clinical case of an 85-year-old patient with Heid’s syndrome is being reported: recurrent gastrointestinal bleeding due to angiodysplasia of the stomach and intestines in combination with acquired destruction of large von Willebrand factor multimers in severe aortic stenosis. Actually it remains difficult to make a diagnosis in these patients and perform timely surgical intervention. Considering the age of the patient, severity of manifestations of heart failure and high risk of surgical complications, transcatheter aortic valve implantation (TAVI) was the method of choice. Surgical correction of heart disease in this case is aimed not only at treating its clinical manifestations, but also at eliminating the cause of recurrent gastrointestinal bleeding in Hyde’s syndrome.
The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.
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