Hemorrhagic ascites from spontaneous ectopic mesenteric varices rupture in NASH induced cirrhosis and successful outcome: A case report

Abstract

Bleeding from gastro-esophageal varices can often present as the first decompensating event in patients with cirrhosis. This can be a potentially life threatening event associated with a 15%-20% early mortality. We present a rare case of new onset ascites due to intra-abdominal hemorrhage from ruptured mesenteric varices; in a 37 years old male with newly diagnosed nonalcoholic steatohepatitis induced cirrhosis as the first decompensating event. The patient was successfully resuscitated with emergent evacuation of ascites for diagnosis, identification and control of bleeding mesenteric varices and eventually orthotopic liver transplantation with successful outcome. Various clinical presentations, available treatment options and outcomes of ectopic variceal bleeding are discussed in this report.

Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis

“…The majority of studies (data sources) were conducted in the USA (n = 18, 58%), no more than 3 studies were conducted in any other country and in total; studies were conducted in 8 different mainly Western countries. Nine studies were specifically aimed at determining HRQoL 14,25,[27][28][29][30][31][32][33] ; 13 studies were focussed on specific related symptoms such as varices, pain or overall physical/mental symptoms [34][35][36][37][38][39][40][41][42][43][44] ; 2 were case studies each describing the experience of a single patient 45,46 ; 3 studies were concerned with PROM development and validation. [47][48][49] Within the identified studies, 1 was an opinion piece 50 ; 5 were conference abstracts 32,33,[42][43][44] and 5 were patient blogs/ stories.…”

“…[47][48][49] Within the identified studies, 1 was an opinion piece 50 ; 5 were conference abstracts 32,33,[42][43][44] and 5 were patient blogs/ stories. [51][52][53][54][55] The majority of the studies (n = 19) specifically identified the inclusion of NASH-cirrhosis patients, 14,[28][29][30]33,[35][36][37][38][39][40][41]43,45,46,49,51,55,56 4 studies were assumed to refer to NASH-cirrhosis-these studies grouped 'other' liver disease aetiologies as 1 group 32,34,43,47 ; the final 7 studies 25,42,48,50,52-54 only referred to their target group as 'cirrhosis patients'.…”

“…42 Compensated and decompensated patients In the studies that considered patients with compensated/ decompensated cirrhosis, using the EQ-5D-3L, it was reported that patients with decompensated cirrhosis had a higher risk of having problems with mobility, self-care and usual activities compared to 'healthy subjects'. 32 Edula et al (2014), in their case study of a patient with NASH-cirrhosis, asserted that bleeding from gastro-oesophageal varices 'can often present as a first decompensating event' 57 for patients with previously identified compensated disease. Patients with NASH-cirrhosis were also reported to be at risk of bleeding from varices (30/47 patients) in the Japanese study by Nakamura et al 58 Grey literature and blogs Findings from the grey literature blogs highlighted perspectives both from patients with NASH-cirrhosis (n = 3) and their spouse/ family members (n = 2).…”

“…It was developed in a group of patients with an established diagnosis of chronic liver disease and various aetiologies included hepatocellular liver disease, chronic hepatitis C, chronic hepatitis B, primary biliary cholangitis, primary sclerosing cholangitis, viral hepatitis B and C-related cirrhosis, alcohol-related cirrhosis and other types of liver disease, with no specific mentioning of NAFLD or NASH. 45 The initial development took place before the publication of FDA guidance for PROMs and was completed by experts with some subsequent patient review, rather than through traditional concept elicitation processes. A list of healthrelated problems likely to be relevant to patients with chronic liver disease was developed by hepatologists and subsequently presented to 60 patients with chronic liver disease, which resulted in the final version of the questionnaire.…”

Hemoperitoneum From Bleeding Intra-Abdominal Varices: A Rare, Life-Threatening Cause of Abdominal Pain in a Patient With Cirrhosis

“…In a literature review of published cases, we identified eight previous case reports of hemoperitoneum in the setting of bleeding ectopic abdominal varices [3,[20][21][22][23][24][25][26]. Four patients underwent exploratory laparotomy with ligation with 100% mortality [21,[24][25].…”