Hepatorenal sendromlu hastada terlipressin’e bağlı skrotal ağrı

Year 2020, Volume: 1 Issue: 1, 10 - 11, 31.03.2020

Rabia Ezber Güray Can Zuhal Mercan Gizem Kahveci Fatime Demir Müjgan Gürler Meral Akdoğan Kayhan

Abstract

Hepatorenal sendrom, refrakter assitin eşlik ettiği kronik karaciğer parankim hastalığı olan hastalarda görülen böbrek yetersizliği tablosudur. Tedavide vazokonstrüktörler verilmektedir. Tedaviye bağlı iskemik komplikasyonlar sıklıkla izlenmekle birlikte, iskemik skrotal ağrı nadirdir. Vakamızda kronik hepatit B’ye bağlı kronik karaciğer parankim hastalığı olan, hepatorenal sendrom gelişmiş bir hasta sunulmuştur. Hepatorenal sendrom için hastaya verilen terlipressin sonrası skrotal ağrı ve skrotal deride hiperemi ortaya çıktı. Terlipressine bağlı iskemik bir komplikasyon olduğu düşünülerek tedavi kesildi. Vazokontrüktör tedaviye bağlı skrotal nekrozlar bildirilmiştir. Bu vakalar genellikle tedavinin 24. saatinden sonra ortaya çıkmaktadır. Vakamızda 1. saatte iskemik bulguların ortaya çıkması olası nekrozun önüne geçmiştir.

Keywords

Hepatorenal sendrom, terlipressin, skrotal iskemi

Scrotal pain related to terlipressin in the patient with hepatorenal syndrome

Abstract

Hepatorenal syndrome is a table of kidney failure seen in patients with chronic liver parenchymal disease accompanied by refractory ascites. Vasoconstrictors are given in its treatment. Treatment-related ischemic complications are frequently observed, but ischemic scrotal pain has not been reported. In our case, a patient with chronic liver parenchymal disease due to chronic hepatitis B and who developed hepatorenal syndrome was presented. Scrotal pain and hyperemia of scrotal skin have appeared after the given terlipressin to the patient for hepatorenal syndrome. Treatment was discontinued due to considering an ischemic complication of terlipressin. Scrotal necrosis related to vasoconstrictor therapy has been previously reported. These complications usually occur after the 24th hour of treatment. The development of ischemic findings at first hour of the treatment have prevented possible necrosis in our case.

Keywords

Hepatorenal syndrome, terlipressin, scrotal ischemia

References

• 1. Betrosian AP, Agarwal B, Douzinas EE. Acute renal dysfunction in liver diseases. World J Gastroenterol 2007 Nov 14; 13: 5552-9.
• 2. Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996; 23: 164-76.
• 3. Schrier RW, Arroyo V, Bernardi M, et al. Peripheral arterial vasodilation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8: 1151– 7.
• 4. Arroyo V, Clària J, Saló J, et al. Antidiuretic hormone and the pathogenesis of water retention in cirrhosis with ascites. Semin Liver Dis 1994; 14: 44– 58.
• 5. Akil ipek, Kasırga Erhun. Hepatorenal sendrom. Erciyes Tıp Derg (Erciyes Med J) 2004; 26: 132-40.
• 6. Lenz K, Hortnagl H, Druml W, et al. Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis. Effects on renal hemodynamics and atrial natriuretic factor. Gastroenterology 1991; 101: 1060-7.
• 7. Rose BD, Runyon BA. Diagnosis and treatment of hepatorenal syndrome. Up To Date 2007.
• 8. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: A double-blind, placebo-controlled trial. Gastroenterology 2000; 119: 1637-48.