Stopping blood vessel bleeds (Nov 14, 2013) - By Joan Chew Over a period of one month earlier this year, retiree Tran Duc Can came face to face with death three times. The 74-year-old had developed the most serious complication of liver cirrhosis (scarring), which is bleeding from a dilated blood vessel in his stomach, known as a gastric varix. The dilated blood vessel burst three times and bled internally. Fortunately, he survived. Studies have shown that one in five of those who has such bleeds dies as a result of internal bleeding. Each time, the Vietnamese man vomited blood, passed black stool and became so weak he could hardly move, recalled his youngest child, 37-year-old Tran Khanh Hoa. Each time, doctors at a hospital in Ho Chi Minh City injected him with a solution which made his blood clot, bringing him back from the brink of death. He was also given medication to control the high blood pressure in his vein, due to the blockage of blood flow throughout his liver. In June, Ms Hoa took her father to Singapore to consult Dr Desmond Wai, who had treated MrCans liver cancer five years ago. Dr Wai, a gastroenterologist and hepatologist at Gleneagles Medical Centre, performed an endoscopy (examination of the food pipe by inserting a long flexible tube with a camera) on him and found that he had a big gastric varix of between 3cm and 4cm in diameter. But there were few treatment options available to Mr Can, a former engineer, who also had encephalopathy, a brain dysfunction caused by the accumulation of toxins in his bloodstream due to an impaired liver. Ms Hoa said he displayed irritability, forgetfulness and depression - symptoms of the brain dysfunction. Dr Wai said a liver transplant was deemed too risky for the elderly man, while another procedure to allow blood to bypass the liver would worsen his encephalopathy and put him at high risk of entering a coma. Instead, Mr Can was offered a relatively new procedure which is deemed less risky for patients whose liver function is severely damaged and who have encephalopathy. The procedure seals off the dilated blood vessel, which halts the bleeding and prevents its recurrence. On June 5, he became one of four patients who has undergone the balloon-occluded retrograde transvenous obliteration (BRTO) procedure here with Dr Terence Teo, a consultant radiologist at ParkwayHealth Radiology. Dr Teo performed his first three cases at Changi General and Singapore General hospitals over the last two years. Dr Sundeep Punamiya, a senior consultant at the department of diagnostic radiology at Tan Tock Seng Hospital, performed one BRTO procedure on a patient at Khoo Teck Puat Hospital last month. He was there as a visiting consultant. Checks with other hospitals showed they have yet to offer BRTO to their patients and rely on older methods to treat varices. Dr Teo estimated that fewer than 10 patients may be put through BRTO a year, largely because liver specialists are doing a good job of controlling the complication of liver cirrhosis with medication before veins enlarge and rupture. After the procedure, Mr Can stayed in Mount Elizabeth Hospital for three days. By the second day, he was well enough to go to the toilet on his own, said Ms Hoa, who is back in Ho Chi Minh City with her father. She added: Hes back to his normal lifestyle now, briskwalking every evening and going to the market with my 73-year-old mother. To read more, pick up Mind Your Body, which comes with The Straits Times today! Or go to: straitstimes/supplements/mind-your-body/story/stopping-blood-vessel-bleeds-20131114
Posted on: Thu, 14 Nov 2013 09:43:26 +0000
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