P1316 - Unveiling Liver Cirrhosis: A Case Study of Portal Hypertensive Colopathy in Guatemala C.A.

Jorge Guillermo Pacheco Oliva, MD, MSc¹, Jose Roberto Aguirre Ayala, MD, MSc², Lemuel Augusto Guerra Folgar, MS³, Abel Alberto Sanchez Orozco, MD, MSc⁴, Bernardo Donery Lopez Samayoa, MD^5
1Roosevelt Hospital at the University of San Carlos de Guatemala, Guatemala, Quetzaltenango, Guatemala; ²Gastroenterology & Digestive Endoscopy Unit of the Roosevelt Hospital at the University of San Carlos de Guatemala, Guatemala, Quetzaltenango, Guatemala; ³Centro Universitario Metropolitano School of Medicine at the University of San Carlos de Guatemala, Guatemala, Sacatepequez, Guatemala; ⁴Gastroenterology & Digestive Endoscopy Unit of the Roosevelt Hospital at the University of San Carlos de Guatemala, Guatemala City, San Marcos, Guatemala; ⁵Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Introduction: Portal Hypertensive Colopathy (PHC) is a condition associated with portal hypertension and liver cirrhosis, leading to potential acute gastrointestinal bleeding and significant life-threatening disease decompensation. In Guatemala, liver cirrhosis is a major public health issue and one of the top ten frequent causes of death. The country has the highest liver cancer rates in Central and South America, primarily due to late-stage diagnosis and limited screening resources. Documenting PHC cases is crucial for raising awareness and improving clinical practice.

Case Description/Methods: A 72-year-old Guatemalan female with chronic liver disease presented with fatigue, anorexia, weight loss, and progressive epigastric pain over one month. Hepatic neoplasm, is documented by imaging, leading to hospital admission.

During hospitalization, she experienced one melena episode, prompting an Upper Gastrointestinal Endoscopy (EGD), which showed small esophageal varices without active bleeding. Three days later, the patient developed hematochezia. A colonoscopy revealed extensive colonic mucosal edema (A) and congestion (B) with petechial erythema (C), indicative of PHC. Histopathological analysis confirmed moderate chronic colitis.

The patient was treated with intravenous Terlipressin, resulting in clinical improvement. She was discharged on carvedilol 6.25 mg every 12 hours for long-term management of portal hypertension. The patient's condition improved with this regimen, and close follow-up.

Discussion: This case underscores the critical importance of recognizing PHC as a potential cause of lower gastrointestinal bleeding in patients with liver disease. Histopathological confirmation of moderate chronic colitis supported the diagnosis. The effective use of intravenous Terlipressin for acute management and carvedilol for long-term control of portal hypertension demonstrated successful stabilization and prevention of recurrent bleeding.

Early recognition is essential for timely intervention. Comprehensive gastrointestinal evaluation is crucial, and the combination of vasoactive drugs with beta-blockers is effective for management. In resource-limited settings like Guatemala, improved access to diagnostic and treatment facilities is essential for better patient outcomes. This case highlights the need for increased vigilance and systematic approaches to diagnosing and managing PHC to prevent severe complications and improve care for patients with liver disease.



Disclosures:


Jorge Guillermo Pacheco Oliva, MD, MSc¹, Jose Roberto Aguirre Ayala, MD, MSc², Lemuel Augusto Guerra Folgar, MS³, Abel Alberto Sanchez Orozco, MD, MSc⁴, Bernardo Donery Lopez Samayoa, MD⁵. P1316 - Unveiling Liver Cirrhosis: A Case Study of Portal Hypertensive Colopathy in Guatemala C.A., ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.