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Portal vein thrombosis  [cached]
Gian Mario Santamaria,Stefania Morelli,Paola Trucco,Piero Davio
Emergency Care Journal , 2005, DOI: 10.4081/ecj.2005.1.10
Abstract: Acute portal vein thrombosis (PVT) is un uncommon disease that can be seen in the Emergency Department. In the emergency department setting the diagnosis is difficult because of the variety of clinical presentation but in some clinical presentation patterns the diagnosis should be suspected. Regard to the appropriate radiological abdominal images, color flow Doppler ultrasonography can diagnose the fresh thrombus and spiral CT may be complementary in the diagnosis. The diagnosis differentiation between acute and chronic portal vein thrombosis is important for therapeutic management and prognosis. In stable patient the most common therapy is heparin and warfarin but in some cases thrombolysis can be the treatment of choice. In the patients with intestinal infarction the surgical therapy is strongly indicated. Two cases , one of acute and the other of chronic PVT, are presented and discussed.
Etiology and portal vein thrombosis in Budd-Chiari syndrome  [cached]
Oguz Uskudar, Meral Akdogan, Nurgul Sasmaz, Sevinc Yilmaz, Muharrem Tola, Burhan Sahin
World Journal of Gastroenterology , 2008,
Abstract: AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS) patients prospectively.METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 2002 and July 2004 as having BCS were studied prospectively. Findings from on physical examination, ultrasonography, duplex ultrasonography and venography were analyzed. Hemogram and blood chemistry were studied at the time of diagnosis and on each hospital visit. Bone marrow examination and immune phenotyping were performed by a hematologist when necessary. Protein C, S, antithrombin III, activated protein C resistance, and anticardiolipin antibodies, antinuclear antibodies, and anti ds-DNA were studied twice. The presence of ascite, esophageal varices, and portal thrombosis were evaluated at admission and on every visit.RESULTS: At least one etiological factor was determined in 54 (72%) of the patients. The etiology could not be defined in 21 (28%) patients. One etiological factor was found in 39, 2 factors in 14 and 3 factors in 1 patient. The most common cause was the web (16%), the second was Hydatid disease (11%), the third was Behcet’s disease (9%). Portal vein thrombosis was present in 11 patients and at least one etiology was identified in 9 of them (82%).CONCLUSION: Behcet’s disease and hydatid disease are more prominent etiological factors in Turkey than in other countries. Patients with web have an excellent response to treatment without signs of portal vein thrombosis while patients having thrombophilic factors more than one are prone to develop portal vein thrombosis with worse clinical outcome.
Anomalous formation of the portal vein: a case report
Gorantla, Vasavi Rakesh;Potu, Bhagath Kumar;Pulakunta, Thejodhar;Vollala, Venkata Ramana;Addala, Pavan Kumar;Nayak, Soubhagya Ranjan;
Jornal Vascular Brasileiro , 2007, DOI: 10.1590/S1677-54492007000400016
Abstract: the knowledge about the formation and relations of the portal vein is important for surgeons and radiologists. the variations in the level of formation and the pattern of formation of portal vein might lead to confusions during radiological and surgical procedures. here we present a rare variation in the formation of the portal vein as found during the cadaveric dissections. the portal vein was formed by the union of splenic vein, superior mesenteric vein and inferior mesenteric veins. the abnormal termination of left gastric vein into superior mesenteric vein before the formation of portal vein was also seen in the same cadaver. identification of these variations is useful in managing traumatic rupture of the mesentery.
Portal vein gas in emergency surgery
Abdulzahra Hussain, Hind Mahmood, Shamsi El-Hasani
World Journal of Emergency Surgery , 2008, DOI: 10.1186/1749-7922-3-21
Abstract: A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008.Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%). This was followed by inflammation of the gastrointestinal tract (16.26%), obstruction and dilatation (9.03%), sepsis (6.6%), iatrogenic injury and trauma (3.01%) and cancer (1.8%). Idiopathic portal vein gas was also reported (1.8%).Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.Portal vein gas (PVG) represents a challenge for diagnosis and management of the underlying surgical cause in emergency surgery. PVG is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe [1]. Mortality could reach 75% [2], however, an increasing number of cases associated with benign conditions suitable for conservative treatment are being reported [3,4]. The majority of patients present acutely to the Accident and Emergency department. Following assessment, surgeons will be alarmed immediately by the patients' critical and unstable condition. A significant number of patients with PVG are misdiagnosed and admitted to the medical ward because they are elderly and unwell and are subsequently not subjected to the specific diagnostic tools. The most common underlying pathology includes bowel ischemia, alteration of the gastrointestinal lining, inflammation and sepsis. However, PVG has recently been recognized as a rare complication of endoscopic and
Anticardiolipin antibodies in children with portal vein thrombosis  [cached]
E. Mahir Gülcan,Tufan Kutlu,Tülay Erkan,Fügen ?ullu ?oku?ra?
Turk Pediatri Ar?ivi , 2009,
Abstract: Aim: The aim of this study was to evaluate the frequency of anticardiolipin antibodies in children with portal vein thrombosis and whether anticardiolipin antibodies have effect on thrombosis in the portal vein.Material and Method: IgG and IgM anticardiolipin levels were measured in 20 patients with portal vein thrombosis and in 20 healthy controls using an ELISA method. Results: IgG anticardiolipin levels (GPL unit) were found as 13.9±4.8 in the portal vein thrombosis patients and 4.4±1.9 in the control group (p<0.05) and IgM anticardiolipin levels (MPL unit) were found as 10.4±5.9 in the portal vein thrombosis patients and in 10.4±0.8 in the control group (p>0.05). In seven (35%) portal vein thrombosis patients and in one (5%) in the control group anticardiolipin IgG (p<0.05) and in two portal vein thrombosis patients (10%) and in two in the control group (10%) anticardiolipin IgM (p>0.05) levels were high (>10 GPL and MPL unit). Conclusions: IgG anticardiolipin antibodies are significantly associated with portal vein thrombosis in children. (Turk Arch Ped 2009; 44: 124-6)
Portal vein thrombosis complicating appendicitis
AA Ayantunde, SA Debrah
West African Journal of Medicine , 2004,
Abstract: Appendicitis is still the most common acute surgical abdomen all over the world and its complications may be grave. We report an adult case of acute appendicitis complicated by Portal Vein Thrombosis (PVT) and ascending portomesenteric phlebitis treated successfully with antibiotics and anticoagulation with no residual morbidity. Review of published works on the subject matter is also presented. Key Words: Appendicitis, Portal vein thrombosis, Pylephlebitis, Anticoagulation, Appendicectomy Résumé L'appendicite demeure un abdomen chirurgical aigu le plus courant partout dans le monde entier et son implication pourrait être sévère. Nous rapportons le cas d'une appendicite aigue compliquée par Portal Veine Thrombose (PVT) et phlébite portomesentugue ascendant soignée connu du succès avec antibiotiques et anticoagulation avec aucune morbidité résiduelle. Il s'agit également d'une présentation d'un bilan des travaux publiés sur le contenu du recherche. West African Journal of Medicine Vol.23(4) 2004: 332-334
Selection and Outcome of Portal Vein Resection in Pancreatic Cancer  [PDF]
Akimasa Nakao
Cancers , 2010, DOI: 10.3390/cancers2041990
Abstract: Pancreatic cancer has the worst prognosis of all gastrointestinal neoplasms. Five-year survival of pancreatic cancer after pancreatectomy is very low, and surgical resection is the only option to cure this dismal disease. The standard surgical procedure is pancreatoduodenectomy (PD) for pancreatic head cancer. The morbidity and especially the mortality of PD have been greatly reduced. Portal vein resection in pancreatic cancer surgery is one attempt to increase resectability and radicality, and the procedure has become safe to perform. Clinicohistopathological studies have shown that the most important indication for portal vein resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins. Otherwise, portal vein resection is contraindicated.
Comparison of percutaneous transhepatic portal vein embolization and unilateral portal vein ligation  [cached]
Hiroya Iida,Tsukasa Aihara,Shinichi Ikuta,Hidenori Yoshie
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i19.2371
Abstract: AIM: To compare the effect of percutaneous transhepatic portal vein embolization (PTPE) and unilateral portal vein ligation (PVL) on hepatic hemodynamics and right hepatic lobe (RHL) atrophy. METHODS: Between March 2005 and March 2009, 13 cases were selected for PTPE (n = 9) and PVL (n = 4) in the RHL. The PTPE group included hilar bile duct carcinoma (n = 2), intrahepatic cholangiocarcinoma (n = 2), hepatocellular carcinoma (n = 2) and liver metastasis (n = 3). The PVL group included hepatocellular carcinoma (n = 2) and liver metastasis (n = 2). In addition, observation of postoperative hepatic hemodynamics obtained from computed tomography and Doppler ultrasonography was compared between the two groups. RESULTS: Mean ages in the two groups were 58.9 ± 2.9 years (PVL group) vs 69.7 ± 3.2 years (PTPE group), which was a significant difference (P = 0.0002). Among the indicators of liver function, including serum albumin, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, platelets and indocyanine green retention rate at 15 min, no significant differences were observed between the two groups. Preoperative RHL volumes in the PTPE and PVL groups were estimated to be 804.9 ± 181.1 mL and 813.3 ± 129.7 mL, respectively, with volume rates of 68.9% ± 2.8% and 69.2% ± 4.2%, respectively. There were no significant differences in RHL volumes (P = 0.83) and RHL volume rates (P = 0.94), respectively. At 1 mo after PTPE or PVL, postoperative RHL volumes in the PTPE and PVL groups were estimated to be 638.4 ± 153.6 mL and 749.8 ± 121.9 mL, respectively, with no significant difference (P = 0.14). Postoperative RHL volume rates in the PTPE and PVL groups were estimated to be 54.6% ± 4.2% and 63.7% ± 3.9%, respectively, which was a significant difference (P = 0.0056). At 1 mo after the operation, the liver volume atrophy rate was 14.3% ± 2.3% in the PTPE group and 5.4% ± 1.6% in the PVL group, which was a significant difference (P = 0.0061). CONCLUSION: PTPE is a more effective procedure than PVL because PTPE is able to occlude completely the portal branch throughout the right peripheral vein.
Ligation of Left Renal Vein for Spontaneous Splenorenal Shunt to Prevent Portal Hypoperfusion after Orthotopic Liver Transplantation  [PDF]
Lampros Kousoulas,Kristina Imeen Ringe,Michael Winkler,Frank Lehner,Nicolas Richter,Juergen Klempnauer,Fabian Helfritz
Case Reports in Transplantation , 2013, DOI: 10.1155/2013/842538
Abstract: We report a case of recovered portal flow by ligation of the left renal vein on the first postoperative day after orthotopic liver transplantation of a 54-year-old female with alcoholic liver cirrhosis, chronic kidney failure, and spontaneous splenorenal shunt. After reperfusion, Doppler ultrasonography showed almost total diversion of the portal flow into the existing splenorenal shunt, but because of severe coagulopathy and diffuse bleeding, ligation of the shunt was not attempted. A programmed relaparotomy was performed on the first postoperative day, and the left renal vein was ligated just to the left of the inferior vena cava. Portal flows subsequently increased to 37?cm/sec, and the patient presented a good and stable liver function. We conclude that patients with known preoperative splenorenal shunts should be closely monitored, and if the portal flow becomes insufficient, ligation of the left renal vein should be attempted in order to optimize the portal perfusion of the liver. 1. Introduction In cirrhotic patients with portal hypertension, collateral vessels into systemic circulation are well known. The amount of collateral flow depends on the stage of portal hypertension. In advanced stages, the development of a reversal hepatofugal portal flow may lead to a portal steal syndrome [1]. After orthotopic liver transplantation, usually the portal flow and pressure normalize and, providing that there is an adequate-sized graft, collateral vessels collapse and obliterate [2–4]. Low portal vein flows after orthotopic liver transplantation, due to persisting splenorenal shunt, are associated with hepatic hypoperfusion and poor allograft survival [2]. Splenorenal shunts are present in cirrhotic patients from nearly 14% up to 21%, and several studies have suggested that spontaneous portosystemic shunts should be treated in order to recover the portal flow of the liver graft [5, 6]. Beside direct division of the shunt vessels with or without splenectomy, the ligation of the left renal vein is described to be an effective technique and has been reported to be safe in adult liver transplant patients with large splenorenal shunts [7–9]. 2. Case Report The patient is a 54-year-old female with alcoholic liver cirrhosis and chronic kidney failure, listed for liver and sequential renal transplantation. The patient underwent a percutaneous ethanol injection therapy for a solitary hepatocellular carcinoma in 2009. At the timepoint of transplantation the MELD score was 37. The preoperatively conducted abdominal computed tomographic (CT) scan showed severe
Portal Vein Thrombosis after Splenectomy  [PDF]
Mohamed Al Saeed
Egyptian Journal of Hospital Medicine , 2012,
Abstract: Background and Aim of the work: Splenectomy is a common operation but it carries the danger of many postoperative complications. One of the most important complications is the portal vein thrombosis (PVT), which may be fatal due to development of bowel ischemia and severe portal hypertension. Due to the effect of hypobaric hypoxia and higher liability for thrombosis encountered in high altitude areas, PVT may represent an actual problem in Taif province. The aim of this retrospective study is to detect the incidence, pattern of presentation, laboratory, radiological and results of treatment of cases of PVT following splenectomy.Methods: In this study, we reviewed all cases of splenectomy performed in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2007 to January 2012. Cases of PVT following splenectomy were analyzed for incidence, pattern of presentation, laboratory, radiological and results of treatment. Results: This study involved 50 patients (40 males and 10 females) admitted in the surgical department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2007 to January 2012. Eight cases of Portal vein thrombosis (16%) out of 50 splenectomies were identified. These 8 patients included: 4/10 of the patients (40%) suffering from myeloproliferative (MP), 3 of them (75%) had spleen weight greater than 3,000 g, 3/12 (25%) of the hemolytic anemia patients, and 1/10 of the patients (10%) operated upon for Hypersplenism. All patients had splenomegaly with mean weight of 1540 Gms (range 460 to 3850 g). Presenting symptoms included; anorexia in 7/8 cases (87.5%), abdominal pain in 6 (75%), and in all cases there was elevation in D-Dimer level, leukocyte and platelet counts. All diagnoses were made by contrast-enhanced computed tomography scan, and anticoagulation was initiated immediately. One/8 patients (12.5%) died from progressive liver cell failure; the others are alive with no clinical sequalae at a mean follow up of 27 months.CONCLUSIONS: PVT is a relatively common complication of splenectomy in patients with Splenomegaly, especially in Taif and related districts in which there is already a higher incidence of thrombotic disorders. The surgeon has to be with high index of suspicion, for early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation for successful outcome.
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