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Fujimoto K, Kondo T, Unozawa H, Koizumi J, Kato N. First Experience With the Utility of ReMAP (Repeatable Microcatheter Access Port) in Portal Vein Stenting. Cureus 2024; 16:e58530. [PMID: 38770468 PMCID: PMC11103942 DOI: 10.7759/cureus.58530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Portal vein stenting is a treatment option for portal hypertension caused by extrahepatic portal vein obstruction or stenosis. However, limited pathways to approach the portal vein are available, hindering re-intervention in the portal vein. Portal vein puncture through the transjugular intrahepatic portosystemic shunt route is less invasive and considered suitable for portal vein stenting. Furthermore, transjugular intrahepatic portosystemic shunting facilitates repeat approaches to the portal vein. However, a transjugular intrahepatic portosystemic shunt stent is not recommended unless necessary because of adverse events, and cannot be retrieved, once placed. Herein, we report on a novel approach using the repeatable microcatheter access port: ReMAP™ (Toray, Tokyo, Japan), a central vein port into which a 2.9 Fr catheter can be inserted. We used it for a repeat approach to the portal vein with only one puncture and without placing a transjugular intrahepatic portosystemic shunt stent.
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Affiliation(s)
| | | | | | | | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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Fusaro L, Di Bella S, Martingano P, Crocè LS, Giuffrè M. Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel) 2023; 13:429. [PMID: 36766534 PMCID: PMC9914785 DOI: 10.3390/diagnostics13030429] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
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Affiliation(s)
- Lisa Fusaro
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Infectious Disease Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Paola Martingano
- Departmet of Radiology, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Lory Saveria Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
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Cutolo C, Fusco R, Simonetti I, De Muzio F, Grassi F, Trovato P, Palumbo P, Bruno F, Maggialetti N, Borgheresi A, Bruno A, Chiti G, Bicci E, Brunese MC, Giovagnoni A, Miele V, Barile A, Izzo F, Granata V. Imaging Features of Main Hepatic Resections: The Radiologist Challenging. J Pers Med 2023; 13:jpm13010134. [PMID: 36675795 PMCID: PMC9862253 DOI: 10.3390/jpm13010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Liver resection is still the most effective treatment of primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and of metastatic disease, such as colorectal liver metastases. The type of liver resection (anatomic versus non anatomic resection) depends on different features, mainly on the type of malignancy (primary liver neoplasm versus metastatic lesion), size of tumor, its relation with blood and biliary vessels, and the volume of future liver remnant (FLT). Imaging plays a critical role in postoperative assessment, offering the possibility to recognize normal postoperative findings and potential complications. Ultrasonography (US) is the first-line diagnostic tool to use in post-surgical phase. However, computed tomography (CT), due to its comprehensive assessment, allows for a more accurate evaluation and more normal findings than the possible postoperative complications. Magnetic resonance imaging (MRI) with cholangiopancreatography (MRCP) and/or hepatospecific contrast agents remains the best tool for bile duct injuries diagnosis and for ischemic cholangitis evaluation. Consequently, radiologists should be familiar with the surgical approaches for a better comprehension of normal postoperative findings and of postoperative complications.
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Affiliation(s)
- Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
- Correspondence:
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy
| | - Piero Trovato
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Nicola Maggialetti
- Department of Medical Science, Neuroscience and Sensory Organs (DSMBNOS), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Alessandra Bruno
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Giuditta Chiti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Eleonora Bicci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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Imaging Features of Main Posthepatectomy Complications: A Radiologist’s Challenge. Diagnostics (Basel) 2022; 12:diagnostics12061323. [PMID: 35741133 PMCID: PMC9221607 DOI: 10.3390/diagnostics12061323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
In the recent years, the number of liver resections has seen an impressive growth. Usually, hepatic resections remain the treatment of various liver diseases, such as malignant tumors, benign tumors, hydatid disease, and abscesses. Despite technical advancements and tremendous experience in the field of liver resection of specialized centers, there are moderately high rates of postoperative morbidity and mortality, especially in high-risk and older patient populations. Although ultrasonography is usually the first-line imaging examination for postoperative complications, Computed Tomography (CT) is the imaging tool of choice in emergency settings due to its capability to assess the whole body in a few seconds and detect all possible complications. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for delineating early postoperative bile duct injuries and ischemic cholangitis that may arise in the late postoperative phase. Moreover, both MDCT and MRCP can precisely detect tumor recurrence. Consequently, radiologists should have knowledge of these surgical procedures for better comprehension of postoperative changes and recognition of the radiological features of various postoperative complications.
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Computed tomography findings of mesenteric ischemia related to acute superior mesenteric vein thrombosis: A case report. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.470446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Regnault H, Emambux S, Lecomte T, Doat S, Dhooge M, Besson M, Dubreuil O, Moryoussef F, Silvain C, Bachet JB, Tougeron D. Clinical outcome of portal vein thrombosis in patients with digestive cancers: A large AGEO multicenter study. Dig Liver Dis 2018; 50:285-290. [PMID: 29183764 DOI: 10.1016/j.dld.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Management of portal vein thrombosis (PVT) in cancer patients remains discussed. AIMS The objective of this multicenter retrospective study was to investigate the management and outcome of PVT in patients with digestive cancers other than hepatocellular carcinoma (HCC). METHOD Main inclusion criteria were trunk or branch PVT in patients with locally advanced or metastatic digestive cancers. Predictive factors of bleeding and overall survival (OS) were evaluated in univariate and multivariate analysis. RESULTS Between 2012 and 2016, 118 patients with PVT and digestive cancers were identified. The majority had a pancreatic cancer (50%). Sixty-six percent of patients had trunk PVT location. Endoscopic screening of portal hypertension was performed in only 7 patients (1%) and 5 had esophageal varices. Gastrointestinal bleeding occurred in 22 patients (19%) and 12 patient deaths (17%) were related to a gastrointestinal hemorrhage. Metastatic disease (HR=2.83 [95%CI 1.47-5.43], p<0.01) and gastrointestinal hemorrhage (HR=1.68 [95%CI 1.01-2.78], p=0.04) were associated with OS in multivariate analysis. Only trunk PVT location was significantly associated with gastrointestinal hemorrhage in multivariate analysis (HR=5.56 [95%CI 1.18-26.32], p=0.03). CONCLUSION A high rate of variceal bleeding leading to death was found in this cohort. Endoscopic screening and the efficacy of prophylactic treatment of variceal bleeding remain to be evaluated in a prospective study.
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Affiliation(s)
- Hélène Regnault
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Sheik Emambux
- Department of Oncology, Poitiers University Hospital, Poitiers, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Université François-Rabelais de Tours, CNRS, GICC UMR, Tours, France
| | - Solene Doat
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Marion Dhooge
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Marie Besson
- Department of Radiology, Tours University Hospital, Tours, France
| | | | - Frederic Moryoussef
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Christine Silvain
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France
| | - Jean-Baptiste Bachet
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France.
| | - David Tougeron
- Department of Oncology, Poitiers University Hospital, Poitiers, France; Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France
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Ahn JH, Yu JS, Cho ES, Chung JJ, Kim JH, Kim KW. Diffusion-Weighted MRI of Malignant versus Benign Portal Vein Thrombosis. Korean J Radiol 2016; 17:533-40. [PMID: 27390544 PMCID: PMC4936175 DOI: 10.3348/kjr.2016.17.4.533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/19/2016] [Indexed: 12/20/2022] Open
Abstract
Objective To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis. Materials and Methods The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40–85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm2 at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. Results The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10-3 mm2/sec and 0.92 ± 0.25 × 10-3 mm2/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10-3 mm2/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9–98.9%) and a sensitivity of 22.2% (95% CI: 6.4–47.6%), respectively. Conclusion Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.
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Affiliation(s)
- Jhii-Hyun Ahn
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Jeong-Sik Yu
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Eun-Suk Cho
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Jae-Joon Chung
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Joo Hee Kim
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Ki Whang Kim
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
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Wu TT, Li HC, Zheng F, Ao GK, Lin H, Li WM. Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience. Cardiovasc Intervent Radiol 2016; 39:994-1000. [PMID: 26943811 DOI: 10.1007/s00270-016-1317-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device. METHODS We collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated. RESULTS The 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA. CONCLUSIONS Percutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.
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Affiliation(s)
- Tian-Tian Wu
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Hu-Cheng Li
- General Surgery Department, The 307th Hospital of PLA, Beijing, 100071, China
| | - Fang Zheng
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Guo-Kun Ao
- Radiology Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Hu Lin
- Radiology Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Wei-Min Li
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China.
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Portal Venous Stent Placement for Malignant Portal Venous Stenosis or Occlusion: Who Benefits? Cardiovasc Intervent Radiol 2015; 38:1515-22. [PMID: 25990622 DOI: 10.1007/s00270-015-1123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/19/2015] [Indexed: 02/08/2023]
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Abstract
As the number of liver resections in the United States has increased, operations are more commonly performed on older patients with multiple comorbidities. The advent of effective chemotherapy and techniques such as portal vein embolization, have compounded the number of increasingly complex resections taking up to 75% of healthy livers. Four potentially devastating complications of liver resection include postoperative hemorrhage, venous thromboembolism, bile leak, and post-hepatectomy liver failure. The risk factors and management of these complications are herein explored, stressing the importance of identifying preoperative factors that can decrease the risk for these potentially fatal complications.
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Affiliation(s)
- Maria C Russell
- Division of Surgical Oncology, Department of Surgery, Emory University Hospital, 550 Peachtree Street Northeast, 9th Floor MOT, Atlanta, GA 30308, USA.
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12
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Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia. Am J Gastroenterol 2012; 107:1579-85. [PMID: 22825367 DOI: 10.1038/ajg.2012.231] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Extrahepatic portal venous system thrombosis (EPVST) occurs in 13% of patients with either recurrent acute (AP) or chronic (CP) alcoholic pancreatitis. The role of thrombophilia has never been assessed in this entity. METHODS All consecutive patients with alcoholic AP or CP were included in a prospective study. All patients underwent a computerized tomography (CT) scan of the pancreas to evaluate EPVST as well as thorough testing for thrombophilia (protein C, S, and antithrombin deficiency, factor II, factor V, and JAK2 gene mutations, homocystein, biological antiphospholipid syndrome). RESULTS A total of 119 patients (male, n=100 (84%); smokers, n=110 (92%)) were included. EPVST was found in 41 patients (35%). The portal, superior mesenteric, or splenic veins were involved in 34%, 24%, and 93% of patients, respectively. Thrombophilia was identified in 18% (n=22), including the biological antiphospholipid syndrome, factor V Leiden mutation, and factor II G20210A gene mutation in 21 (17.6%), 2 (1.6%), and 1 patient (0.8%), respectively. On univariate analysis, the factors associated with EPVST were smoking (RR=1.6 (1.38-1.85), P=0.03), pseudocysts (RR=2.91 (1.29-6.56), P=0.008), a pseudocyst in the pancreatic tail (P=0.03), a high CT severity index for AP (P=0.007), and pancreatic parenchymal necrosis (P=0.02). The presence of hemostatic risk factors was not associated with an increased risk of EPVST. On multivariate analysis, only pseudocysts were associated with EPVST (hazard ratio: 6.402; 95% confidence interval (1.59-26.54), P=0.009). CONCLUSIONS EPVST is found in 35% of patients with acute/chronic alcoholic pancreatitis. Local inflammation appears to be the major predisposing condition. The presence of some form of thrombophilia does not increase the risk of EPVST and should not be systematically searched for in case of EPVST.
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Martin G, Rashid A, Abdul-Jabar HB, Jennings S. Portal vein thrombosis after total knee replacement: a case report. J Orthop Surg (Hong Kong) 2012; 20:276-8. [PMID: 22933697 DOI: 10.1177/230949901202000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a 74-year-old woman who developed a portal vein thrombosis following an elective total knee replacement. She had atrial fibrillation for which she was taking warfarin for anticoagulation. Seven days prior to surgery, she was instructed to discontinue warfarin and replace it with prophylactic low-molecular-weight heparin. On postoperative day 1, routine blood tests revealed deranged hepatic synthetic function, despite standard anticoagulation management. Doppler ultrasonography confirmed a portal vein thrombosis. She was treated with therapeutic doses of low-molecular-weight heparin until her international normalised ratio reached therapeutic levels. Her liver function results had normalised 2 weeks later. Portal vein thrombosis is a potentially fatal complication that is reversible if identified and treated early.
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Affiliation(s)
- Guy Martin
- Department of Trauma and Orthopaedics, Northwick Park Hospital, Middlesex, Harrow, United Kingdom
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Improving survival in decompensated cirrhosis. Int J Hepatol 2012; 2012:318627. [PMID: 22811919 PMCID: PMC3395145 DOI: 10.1155/2012/318627] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 12/11/2022] Open
Abstract
Mortality in cirrhosis is consequent of decompensation, only treatment being timely liver transplantation. Organ allocation is prioritized for the sickest patients based on Model for End Stage Liver Disease (MELD) score. In order to improve survival in patients with high MELD score it is imperative to preserve them in suitable condition till transplantation. Here we examine means to prolong life in high MELD score patients till a suitable liver is available. We specially emphasize protection of airways by avoidance of sedatives, avoidance of Bilevel Positive Airway Pressure, elective intubation in grade III or higher encephalopathy, maintaining a low threshold for intubation with lesser grades of encephalopathy when undergoing upper endoscopy or colonoscopy as pre transplant evaluation or transferring patient to a transplant center. Consider post-pyloric tube feeding in encephalopathy to maintain muscle mass and minimize risk of aspiration. In non intubated and well controlled encephalopathy, frequent physical mobility by active and passive exercises are recommended. When renal replacement therapy is needed, night-time Continuous Veno-Venous Hemodialysis may be useful in keeping the daytime free for mobility. Sparing and judicious use of steroids needs to be borne in mind in treatment of ARDS and acute hepatitis from alcohol or autoimmune process.
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Abraham MN, Mathiason MA, Kallies KJ, Cogbill TH, Shapiro SB. Portomesenteric venous thrombosis: a community hospital experience with 103 consecutive patients. Am J Surg 2011; 202:759-63; discussion 763-4. [DOI: 10.1016/j.amjsurg.2011.06.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/07/2011] [Accepted: 06/28/2011] [Indexed: 12/15/2022]
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Septic thrombophlebitis of the portal venous system: clinical and imaging findings in thirty-three patients. Dig Dis Sci 2011; 56:2179-84. [PMID: 21221797 DOI: 10.1007/s10620-010-1533-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 12/09/2010] [Indexed: 01/30/2023]
Abstract
AIM Our purpose was to review the clinical and imaging findings in a series of patients with septic thrombophlebitis of the portal venous system in order to define criteria that might allow more confident and timely diagnosis. MATERIALS AND METHODS This is a retrospective case series. The clinical and imaging features were analyzed in 33 subjects with septic thrombophlebitis of the portal venous system. RESULTS All 33 patients with septic thrombophlebitis of the portal venous system had pre-disposing infectious or inflammatory processes. Contrast-enhanced CT studies of patients with septic thrombophlebitis typically demonstrate an infectious gastrointestinal source (82%), thrombosis (70%), and/or gas (21%) of the portal system or its branches, and intrahepatic abnormalities such as a transient hepatic attenuation difference (THAD) (42%) or abscess (61%). CONCLUSIONS Septic thrombophlebitis of the portal system is often associated with an infectious source in the gastrointestinal tract and sepsis. Contrast-enhanced CT demonstrates an infectious gastrointestinal source, thrombosis or gas within the portal system or its branches, and intrahepatic abnormalities such as abscess in most cases. We report a THAD in several of our patients, an observation that was not made in prior reports of septic thrombophlebitis.
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Portal vein thrombosis associated with ischemic colitis. Clin J Gastroenterol 2011; 4:147-150. [DOI: 10.1007/s12328-011-0214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. ACTA ACUST UNITED AC 2010; 42:804-11. [PMID: 20735334 DOI: 10.3109/00365548.2010.508464] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pylephlebitis is a condition with significant morbidity and mortality. We review herein 100 relevant case reports published since 1971. Eighty-one patients were reported with acute pylephlebitis, while the remaining patients had chronic pylephlebitis. The most common predisposing infections leading to pylephlebitis were diverticulitis and appendicitis. Cultures from blood or other tissues were positive in 77%. The infection was polymicrobial in half of the patients and the most common isolates were Bacteroides spp, Escherichia coli and Streptococcus spp. Thrombosis was extended to the superior mesenteric vein (SMV), splenic vein, and intrahepatic branches of the portal vein (PV) in 42%, 12%, and 39%, respectively. Antibiotics were administered in all and anticoagulation in 35 cases. Patients who received anticoagulation had a favourable outcome compared to those who received antibiotics alone (complete recanalization 25.7% vs 14.8% (p > 0.05), no recanalization 5.7% vs 22.2% (p < 0.05), and death 5.7% vs 22.2% (p < 0.01)). Cases with complete recanalization had prompt diagnosis and management and two-thirds were recently published. Nineteen patients died; the majority of these (73.7%) died over the period 1971-1990. In conclusion, pylephlebitis remains an entity with high morbidity and mortality, but modern imaging modalities have facilitated an earlier diagnosis and have improved the prognosis. Anticoagulation has a rather beneficial effect on patients with pylephlebitis.
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Affiliation(s)
- Theoni Kanellopoulou
- Second Department of Medicine, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
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19
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Thomas RM, Ahmad SA. Management of acute post-operative portal venous thrombosis. J Gastrointest Surg 2010; 14:570-7. [PMID: 19582513 DOI: 10.1007/s11605-009-0967-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 06/22/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Portal vein thrombosis can be a devastating, but often overlooked, complication of hepatobiliary procedures. Symptoms of acute portal vein thrombosis range from nondescript abdominal pain to septic shock secondary to mesenteric ischemia. DISCUSSION The surgeon must be cognizant of these symptoms and the potential for portal vein thrombosis after any hepatobiliary procedures as an expedient diagnosis and treatment is necessary in order to prevent thrombus propagation, bowel ischemia, and death. This report outlines the symptoms, diagnosis, and a review of the literature on the treatment of acute portal vein thrombosis after hepatobiliary surgery with a special note made regarding a case of portal vein thrombosis after pancreatectomy and autologous islet cell transplantation.
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Affiliation(s)
- Ryan M Thomas
- Department of Surgery, Division of Surgical Oncology, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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20
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Parikh S, Shah R, Kapoor P. Portal vein thrombosis. Am J Med 2010; 123:111-9. [PMID: 20103016 DOI: 10.1016/j.amjmed.2009.05.023] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/23/2009] [Accepted: 05/18/2009] [Indexed: 02/07/2023]
Abstract
Portal vein thrombosis is a condition not infrequently encountered by clinicians. It results from a combination of local and systemic prothrombotic risk factors. The presentation of acute thrombosis varies widely from an asymptomatic state to presence of life-threatening intestinal ischemia and infarction. In the chronic stage, patients typically present with variceal bleeding or other complications of portal hypertension. Abdominal ultrasound color Doppler imaging has a 98% negative predictive value, and is considered the imaging modality of choice in diagnosing portal vein thrombosis. Controlled clinical trials to assist with clinical decision-making are lacking in both acute and chronic portal vein thrombosis. Oral anticoagulant therapy is initiated if the risks of bleeding are low, but long-term anticoagulation is generally not recommended in patients with concomitant hepatic cirrhosis. The roles of invasive therapeutic approaches such as thrombolysis and transjugular intrahepatic portosystemic shunt continue to evolve. This review conflates dissenting views into a rational approach of managing patients with portal vein thrombosis for the general internist.
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Affiliation(s)
- Sameer Parikh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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21
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Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Maurizio LD, Bombardieri G, Cristofaro RD, Gaetano AMD, Landolfi R, Gasbarrini A. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment. World J Gastroenterol 2010; 16:143-55. [PMID: 20066733 PMCID: PMC2806552 DOI: 10.3748/wjg.v16.i2.143] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient’s outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients’ future prognoses.
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22
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Hwang MW, Kim BN. Pylephlebitis: Report of a Case Secondary to Appendicitis and Review of Cases Reported in Korea. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.3.203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mee Won Hwang
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
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23
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Abstract
Portal vein thrombosis (PVT) is observed in 10-20% of patients with liver cirrhosis, which is responsible for 20% of all PVT cases. The main pathogenic factor of PVT in cirrhosis is the obstacle to portal flow, but acquired and inherited clotting abnormalities may play a role. The formation of collateral veins allows many patients to remain asymptomatic and prevents the onset of clinical complications also in patients with totally occlusive PVT. Gastrointestinal bleeding, thrombosis of superior mesenteric vein and refractory ascites are typical manifestations of PVT. Instrumental diagnosis can be obtained by colour-doppler ultrasonography. Future studies should verify whether asymptomatic PVT worsens liver failure, or if its life-threatening complications reduce survival in patients with cirrhosis. Moreover, randomized controlled trials should clarify the potential effectiveness of anticoagulant therapy in the treatment of PVT.
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Affiliation(s)
- Filippo Luca Fimognari
- Division of Internal Medicine, ASL Roma G, Leopoldo Parodi-Delfino Hospital, Colleferro, Rome, Italy.
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24
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Watanabe H, Muguruma T, Idoguchi K, Matsuoka T. Percutaneous drainage for suppurative pylethrombophlebitis developing in a patient with chronic pancreatitis. J Gastroenterol 2007; 42:589-92. [PMID: 17653656 DOI: 10.1007/s00535-007-2053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 03/06/2007] [Indexed: 02/04/2023]
Abstract
Suppurative pylethrombophlebitis is an extremely rare disease with high mortality. It is difficult to diagnose this disease because its nonspecific clinical features are unfamiliar to physicians. A 64-year-old Asian man, who had undergone a longitudinal pancreaticojejunostomy for alcoholic chronic pancreatitis 7 years before, had right upper abdominal pain and high fever. Abdominal sonography and contrast-enhanced abdominal computed tomography detected thrombus and fluid collection in the portal vein. After a percutaneous needle puncture, the patient was diagnosed as having suppurative pylethrombophlebitis and treated with only drainage and antibiotics; no operation was required. This case suggests that minimally invasive percutaneous needle puncture of the intrahepatic portal vein may be an accurate procedure for the appropriate diagnosis and treatment of suppurative pylethrombophlebitis.
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Affiliation(s)
- Hiroaki Watanabe
- Senshu Critical Care Medical Center, 2-24 Rinku-Orai-Kita, Izumisano 598-0048, Japan
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25
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Domajnko B, Kumar A, Salloum RM. Mesenteric Venous Thrombophlebitis–Septic Thrombophlebitis of the Inferior Mesenteric Vein: An Unusual Manifestation of Diverticulitis. Am Surg 2007. [DOI: 10.1177/000313480707300420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a 57-year-old female patient who presented with fever, abdominal pain, and bacteremia. A CT scan demonstrated sigmoid diverticulitis and air within the inferior mesenteric vein. The patient underwent exploratory laparotomy and sigmoid colectomy. She was discharged without complications. Septic thrombophlebitis of the inferior mesenteric vein is a rare complication of diverticulitis. It may manifest as bacteremia not responding to intravenous antibiotics. CT scan findings are diagnostic, and include evidence of intraluminal gas within the inferior mesenteric vein. As with any case of complicated diverticulitis, the treatment is surgical resection of the involved colon.
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Affiliation(s)
- Bastian Domajnko
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Amit Kumar
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Rabih M. Salloum
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
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26
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Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: Prevalence, patient characteristics and lifetime risk: A population study based on 23 796 consecutive autopsies. World J Gastroenterol 2006; 12:2115-9. [PMID: 16610067 PMCID: PMC4087695 DOI: 10.3748/wjg.v12.i13.2115] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the lifetime cumulative incidence of portal venous thrombosis (PVT) in the general population.
METHODS: Between 1970 and 1982, 23 796 autopsies, representing 84% of all in-hospital deaths in the Malmö city population, were performed, using a standardised protocol including examination of the portal vein. PVT patients were characterised and the PVT prevalence at autopsy, an expression of life-time cumulative incidence, assessed in high-risk disease categories and expressed in terms of odds ratios and 95% CI.
RESULTS: The population prevalence of PVT was 1.0%. Of the 254 patients with PVT 28% had cirrhosis, 23% primary and 44% secondary hepatobiliary malignancy, 10% major abdominal infectious or inflammatory disease and 3% had a myeloproliferative disorder. Patients with both cirrhosis and hepatic carcinoma had the highest PVT risk, OR 17.1 (95% CI 11.1 - 26.4). In 14% no cause was found; only a minority of them had developed portal-hypertension-related complications.
CONCLUSION: In this population-based study, PVT was found to be more common than indicated by previous clinical series. The markedly excess risk in cirrhosis and hepatic carcinoma should warrant an increased awareness in these patients for whom prospective studies of directed intervention might be considered.
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Affiliation(s)
- Mats Ogren
- Department of Vascular Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
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27
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Hidajat N, Stobbe H, Griesshaber V, Felix R, Schroder RJ. Imaging and radiological interventions of portal vein thrombosis. Acta Radiol 2005; 46:336-43. [PMID: 16136689 DOI: 10.1080/02841850510021157] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Portal vein thrombosis (PVT) is diagnosed by imaging methods. Once diagnosed by means of ultrasound, Doppler ultrasound can be performed to distinguish between a benign and malignant thrombus. If further information is required, magnetic resonance angiography or contrast-enhanced computed tomography is the next step, and if these tests are unsatisfactory, digital subtraction angiography should be performed. Many papers have been published dealing with alternative methods of treating PVT, but the material is fairly heterogeneous. In symptomatic non-cavernomatous PVT, recanalization using local methods is recommended by many authors. Implantation of transjugular intrahepatic portosystemic shunt is helpful in cirrhotic patients with non-cavernomatous PVT in reducing portal pressure and in diminishing the risk of re-thrombosis. In noncirrhotic patients with recent PVT, some authors recommend anticoagulation alone. In chronic thrombotic occlusion of the portal vein, local measures may be implemented if refractory symptoms of portal hypertension are evident.
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Affiliation(s)
- N Hidajat
- Central Department of Diagnostic and Interventional Radiology, Hospital Peine, Academic Teaching Hospital of the University of Hannover, Germany.
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28
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Shan H, Xiao XS, Huang MS, Ouyang Q, Jiang ZB. Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis. World J Gastroenterol 2005; 11:3315-8. [PMID: 15929192 PMCID: PMC4316073 DOI: 10.3748/wjg.v11.i21.3315] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the value of endovascular stent in the treatment of portal hypertension caused by benign main portal vein stenosis.
METHODS: Portal vein stents were implanted in six patients with benign main portal vein stenosis (inflammatory stenosis in three cases, postprocedure of liver transplantation in another three cases). Changes in portal vein pressure, portal vein patency, relative clinical symptoms, complications, and survival were evaluated.
RESULTS: Six metallic stents were successfully placed across the portal vein stenotic or obstructive lesions in six patients. Mean portal venous pressure decreased significantly after stent implantation from (37.3±4.7) cm H2O to (18.0±1.9) cm H2O. The portal blood flow restored and the symptoms caused by portal hypertension were eliminated. There were no severe procedure-related complications. The patients were followed up for 1-48 mo. The portal vein remained patent during follow-up. All patients survived except for one patient who died of other complications of liver transplantation.
CONCLUSION: Percutaneous portal vein stent placement for the treatment of portal hypertension caused by benign main portal vein stenosis is safe and effective.
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Affiliation(s)
- Hong Shan
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai 200433, China.
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29
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Kaido T, Kano M, Suzaki S, Yanagibashi K, Shiota M. Colon stenosis caused by old portal vein thrombosis. ACTA ACUST UNITED AC 2005; 30:358-60. [PMID: 15654575 DOI: 10.1007/s00261-004-0247-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 58-year-old female with a history of portal vein thrombosis was referred to our hospital with abdominal pain and distention. Colon fiber and enema of the colon showed stenosis at the transverse colon and the ascending colon, with edematous mucosa. Laparotomy revealed no abnormal findings other than chronic ischemia of the colon. To our knowledge, this is the first reported case of colon stenosis caused by portal vein thrombosis.
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Affiliation(s)
- T Kaido
- Department of Surgery, Otsu Municipal Hospital, 2-9-9-Motomiya, Otsu, Shiga 520-0804, Japan.
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30
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Bleeker-Rovers CP, Jager G, Tack CJ, Van Der Meer JWM, Oyen WJG. F-18-fluorodeoxyglucose positron emission tomography leading to a diagnosis of septic thrombophlebitis of the portal vein: description of a case history and review of the literature. J Intern Med 2004; 255:419-23. [PMID: 14871467 DOI: 10.1046/j.1365-2796.2003.01259.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pylephlebitis or septic thrombophlebitis of the portal vein is a serious infectious disorder. Early diagnosis is difficult, due to nonspecific symptoms and signs, limitations of diagnostic modalities and the lack of familiarity of physicians with this entity. We report the history of a 73-year-old man with fever of unknown origin (FUO) in whom laboratory tests, blood and urine cultures, chest X-ray, abdominal ultrasound, and Indium-111-leucocyte scintigraphy did not reveal the cause of the fever. F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) subsequently pointed to the diagnosis of pylephlebitis, which was confirmed by computed tomography (CT) and percutaneous puncture. We conclude that FDG PET allows detecting inflammatory foci in patients with FUO and offers to make the diagnosis of pylephlebitis at an early stage.
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Affiliation(s)
- C P Bleeker-Rovers
- Department of Internal Medicine, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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31
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Kim DY, Sedlack RE, Brandhagen DJ, Nyberg SL. Late presentation of pylephlebitis after orthotopic liver transplantation. Liver Transpl 2003; 9:776-7. [PMID: 12827569 DOI: 10.1053/jlts.2003.50075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Dean Y Kim
- Department of Surgery, Division of Transplantation Surgery, William J. von Liebig Transplant Center, Mayo Medical School, Foundation, and Clinic, Rochester, MN 55905, USA
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Uflacker R. Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis. Tech Vasc Interv Radiol 2003; 6:59-69. [PMID: 12772131 DOI: 10.1053/tvir.2003.36433] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Portal vein thrombosis (PVT) is an uncommon cause for presinusoidal portal hypertension. PVT can be caused by one of three broad mechanisms: (1) spontaneous thrombosis when thrombosis develops in the absence of mechanical obstruction, usually in the presence of inherited or acquired hypercoagulable states; (2) intrinsic mechanical obstruction because of vascular injury and scarring or invasion by an intrahepatic or adjacent tumor; or (3) extrinsic constriction by adjacent tumor, lymphadenopathy or inflammatory process. Usually, several combined factors are necessary to result in PVT. The consequences of portal vein thrombosis are mostly related to the extension of the clot within the vein. Gastrointestinal bleeding from gastroesophageal varices is the most frequent presentation. Noninvasive imaging techniques are currently used for the screening of patients and the initial diagnosis of PVT. The invasive techniques are reserved for cases when noninvasive techniques are inconclusive, before percutaneous interventional treatment, or in preoperative assessment of patients who are candidates for surgery. Recanalization of the portal vein with anticoagulation alone may not be consistent or appropriate in highly symptomatic patients. Catheterization of the superior mesenteric artery (SMA) is helpful for diagnosis as well as for therapy by allowing the intra-arterial infusion of thrombolytic drugs in the same setting. Direct transhepatic portography allows precise determination of the degree of stenosis and extension within the portal vein, as well as pressure measurements. Thrombotic occlusions of the portal, mesenteric, and splenic veins can be managed by mechanical thrombectomy (MT) or pharmacologic thrombolysis. Underlying occlusions because of organized or refractory thrombus or fixed venous stenosis are best corrected by balloon angioplasty and stent placement. Access into the portal venous system can also be established through creating a transjugular intrahepatic portosystemic shunt (TIPS). Creating a TIPS is also important in the setting of PVT associated with cirrhosis to decompress portal hypertension and improve portal venous flow. PVT involving the portal, splenic, and/or mesenteric veins can also complicate a preexisting TIPS in which case the shunt can be readily used as therapy access. Several techniques may be used to recanalize the shunt and portal venous system, including thrombolytic therapy, balloon angioplasty/embolectomy, suction embolectomy, basket extraction of clots, and mechanical thrombectomy with a variety of devices. Advantages of MT include the potential to rapidly remove thrombus without the need for prolonged thrombolytic infusions, and reducing the potential life-threatening complications of thrombolytic therapy. Possible drawbacks include the risk of intimal or vascular trauma to the portal vein, which may promote recurrent thrombosis.
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Affiliation(s)
- Renan Uflacker
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29245, USA
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Sywak M, Romano C, Raber E, Pasieka JL. Septic thrombophlebitis of the inferior mesenteric vein from sigmoid diverticulitis. J Am Coll Surg 2003; 196:326-7. [PMID: 12602366 DOI: 10.1016/s1072-7515(02)01767-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
These liver diseases are diseases of the hepatic circulation. Myeloproliferative disorders are among the most common prothrombotic disorders that lead to Budd-Chiari syndrome and PVT. SOS, previously known as hepatic veno-occlusive disease, is mainly seen in North America and Western Europe as a complication of the conditioning regimen for hematopoietic stem cell transplantation. SOS is caused by damage to SECs, and the initiating circulatory blockage occurs because of the embolism of sinusoidal lining cells. Myeloproliferative disorders are an uncommon cause of NRH, which is believed to be caused by uneven perfusion of the liver at the venous or sinusoidal level. Peliosis hepatis is believed to result from damage to SECs and is seen mainly in immunosuppressed patients, patients with a wasting illness, or patients with a drug toxicity.
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Affiliation(s)
- Vijayrama Poreddy
- Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, 2011 Zonal Avenue, HMR 603, Los Angeles, CA 90293, USA
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Chandra S, Dutta U, Das R, Vaiphei K, Nagi B, Singh K. Mesenteric venous thrombosis causing jejunal stricture: secondary to hypercoagulable states and primary portal hypertension. Dig Dis Sci 2002; 47:2017-9. [PMID: 12353848 DOI: 10.1023/a:1019664627149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- S Chandra
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Abstract
Portal vein thrombosis (PVT) is an uncommon cause for presinusoidal portal hypertension. Although several predisposing conditions are known to exist in the background of PVT, there still remains a proportion of patients in whom the etiology is not known and the pathogenesis is unclear. In this review we summarize the literature on PVT and present the current knowledge about the precipitating factors of PVT. Further, we discuss the advances in the radiological diagnosis that have improved diagnostic accuracy and are noninvasive. Finally, we discuss the treatment options for patients who have varying extents of thrombosis in the portal vein and specifically focus on PVT that is encountered before and after liver transplantation.
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Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Terada N, Takeda K. Malignant portal venous obstructions treated by stent placement: significant factors affecting patency. J Vasc Interv Radiol 2001; 12:1407-15. [PMID: 11742015 DOI: 10.1016/s1051-0443(07)61699-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify factors affecting stent occlusion after stent placement in the portal vein in patients with malignant portal vein invasion. MATERIALS AND METHODS Forty patients were studied. Twenty-three patients had hepatocellular carcinoma, nine patients had pancreatic cancer, and eight patients had bile duct cancer. Stents were placed in the portal venous system across stenotic (n = 28) or obstructive (n = 12) lesions after percutaneous transhepatic portography. Bare stents were used in 33 patients and covered stents were used in seven patients. Twenty-two variables were analyzed with use of univariate and multivariate analyses to identify significant factors affecting stent occlusion. RESULTS Stents remained patent during a mean follow-up period of 11.9 months (range, 2-61 mo) in 60% of the patients. Stent occlusion was found in 40% of the patients, with a mean period until occlusion of 3.7 months (range, 0.2-16 mo). In the univariate analysis, the following five factors were significantly associated with a higher probability of stent occlusion: (i) splanchnic vein involvement, (ii) Child-Pugh class C, (iii) obstruction of the portal venous system, (iv) pancreatic cancer, and (v) lack of anticancer treatment after stent placement. In the multivariate analysis, the first three factors were found to have independent value for stent occlusion. CONCLUSIONS Splanchnic vein involvement, severe hepatic dysfunction, and obstruction of the portal venous system are the most important factors affecting stent occlusion in patients with malignant portal vein invasion.
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Affiliation(s)
- K Yamakado
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Abstract
Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era.
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Affiliation(s)
- K Vanamo
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
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39
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Abstract
The purpose of this study is to determine the role of CT in the evaluation and in detecting complications in patients with toxic megacolon. A retrospective analysis of CT findings of 18 consecutive patients with toxic megacolon was performed. Underlying etiology included 12 patients with pseudomembranous colitis (PC), four patients with ulcerative colitis and two patients with cytomegalovirus colitis. Eleven patients were HIV+. CT features, correlation with severity of disease and development of complications were analyzed. Colonic dilatation with intraluminal air and/or fluid with a distorted colonic contour or an ahaustral pattern was seen in all patients. In four patients (22%), CT depicted complications-two colonic perforations and two septic thrombosis of the portal system. Six patients died (33%), three of whom had the above complications. The presence and degree of submucosal edema (accordion sign, target sign), wall thickening, degree of dilatation, nodular contour and ascites did not correlate with clinical outcome. Two thirds of patients with toxic megacolon had PC as the underlying etiology. CT was helpful in depicting diffuse colitis, and it was instrumental in detecting life-threatening abdominal complications, contributing to the management of these patients. CT abnormalities cannot be used to predict the clinical outcome unless complications develop.
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Affiliation(s)
- M Imbriaco
- Department of Radiology and National Research Council, University Federico, Naples, Italy
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Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Isaji S, Kawarada Y, Takeda K. Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience. Radiology 2001; 220:150-6. [PMID: 11425988 DOI: 10.1148/radiology.220.1.r01jl03150] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the clinical usefulness of portal venous stent placement in patients with pancreatic or biliary neoplasms invading portal veins and causing portal hypertension. MATERIALS AND METHODS Thirteen patients underwent portal venous stent placement because of gastrointestinal bleeding (n = 8), risk of gastroesophageal varix rupture (n = 4), ascites (n = 4), thrombocytopenia (n = 3), and/or portal venous thrombosis (n = 3). The main portal vein or both the intrahepatic and main portal veins were invaded in six patients (group A). The main portal vein and splanchnic veins were involved in seven patients (group B). Stents were placed across the stenotic (n = 8) or occluded (n = 5) lesions after percutaneous transhepatic portography. Changes in portal venous pressure, stent patency, and survival were evaluated. RESULTS Mean portal venous pressure decreased significantly immediately after stent placement, from 24.9 mm Hg +/- 5.9 (SD) to 15.8 mm Hg +/- 4.6 (P <.001). In group A, blood flow through the stent was maintained and the symptoms had subsided at follow-up (mean, 12.5 months). In group B, symptoms were improved in five patients, but the stents were occluded in all but one patient at a mean follow-up of 1.5 months. There was a significant difference in stent patency between the patients with (14%) and those without (100%) splanchnic venous involvement (P <.01). CONCLUSION Stent placement helped to relieve portal hypertension symptoms. Splanchnic venous involvement was associated with worse stent patency.
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Affiliation(s)
- K Yamakado
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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41
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Antoch G, Hansen O, Pourhassan S, Stock W. Ischaemic jejunal stenosis complicating portal and mesenteric vein thrombosis: a report of two cases. Eur J Gastroenterol Hepatol 2001; 13:707-10. [PMID: 11434598 DOI: 10.1097/00042737-200106000-00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A major complication of portal and mesenteric vein thrombosis is acute bowel ischaemia resulting in infarction and requiring immediate resection of the involved segment. Sufficient collaterals can prevent acute haemorrhagic infarction, but bowel stenosis due to chronic ischaemia may develop. We report two cases of ischaemic jejunal stenosis occurring 4 weeks after successful treatment of portal and mesenteric vein thrombosis. Diagnosis of high-grade segmental stenosis of the jejunum was established by contrast medium radiography of the gastrointestinal tract. After laparotomy and resection of the stenosed jejunal segment, both patients recovered well from the operation and were released from hospital. Follow-up examinations revealed an unremarkable state of health. Ischaemic bowel stenosis should be considered in patients with recurring abdominal pain after mesenteric and portal vein thrombosis. A close follow-up of every patient after treatment for mesenteric and portal vein thrombosis should be carried out to ensure early diagnosis of this complication.
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Affiliation(s)
- G Antoch
- Department of General and Vascular Surgery, Marien-Hospital Düsseldorf, Germany
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42
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Divino CM, Park IS, Angel LP, Ellozy S, Spiegel R, Kim U. A retrospective study of diagnosis and management of mesenteric vein thrombosis. Am J Surg 2001; 181:20-3. [PMID: 11248170 DOI: 10.1016/s0002-9610(00)00532-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mesenteric vein thrombosis (MVT) is an uncommon type of intestinal ischemia associated with significant mortality and morbidity because of its delay in diagnosis. METHODS A retrospective analysis of 9 patients treated surgically for MVT during 1982 to 1997 was performed. RESULTS Nine patients underwent surgical therapy for intestinal ischemia due to MVT. The most common presenting symptom was abdominal pain with bloody diarrhea in 3 patients; preoperative diagnosis of MVT was suspected in 2. Radiologic tests included plain roentgenograms, computed axial tomography, and ultrasound. Time to surgery ranged from 3 hours to 7 days after admission. All patients underwent resection of infarcted bowel with primary anastomosis and immediate postoperative anticoagulation. No patient underwent a second-look operation. The postoperative morbidity and mortality rates were 55% and 11%, respectively. CONCLUSION Diagnosis of intestinal ischemia from MVT is often delayed, and strong clinical suspicion and aggressive treatment are necessary in its management.
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Affiliation(s)
- C M Divino
- Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1259, 10029, New York, NY, USA.
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43
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Balthazar EJ, Gollapudi P. Septic thrombophlebitis of the mesenteric and portal veins: CT imaging. J Comput Assist Tomogr 2000; 24:755-60. [PMID: 11045699 DOI: 10.1097/00004728-200009000-00017] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pylephlebitis or septic thrombophlebitis of the portal vein and its tributaries is an acute ascending infection arising often from a primary gastrointestinal inflammatory lesion. Common primary sources of infection are diverticulitis, appendicitis, and infected pancreatic necrosis. CT imaging can diagnose this complication at an early stage and can significantly improve the previously reported high mortality and morbidity rates associated with this condition.
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Affiliation(s)
- E J Balthazar
- Department of Radiology, New York University, Tisch Medical Center, New York 10016, USA
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Vivas I, Bilbao JI, Martínez-Cuesta A, Benito A, Delgado C, Velázquez P. Combination of various percutaneous techniques in the treatment of pylephlebitis. J Vasc Interv Radiol 2000; 11:777-80. [PMID: 10877426 DOI: 10.1016/s1051-0443(07)61640-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- I Vivas
- Servicio de Radiología, Clinica Universitaria, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain
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45
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46
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Yang YY, Chan CC, Wang SS, Chiu CF, Hsu HC, Chiang JH, Tasy SH, Chang FY, Lee SD. Case report: portal vein thrombosis associated with hereditary protein C deficiency: a report of two cases. J Gastroenterol Hepatol 1999; 14:1119-23. [PMID: 10574141 DOI: 10.1046/j.1440-1746.1999.02017.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Protein C deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein C deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70-140%) plasma protein C level, he was diagnosed as having protein C deficiency. A trace of his family history showed that his elder brother also had protein C deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life-saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein C deficiency with portal vein thrombosis.
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Affiliation(s)
- Y Y Yang
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China
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47
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Abstract
The author reports a case of oral contraceptive-induced mesenteric venous thrombosis with resultant intestinal ischemia in a young woman. The relationship between mesenteric venous thrombosis and oral contraceptives is discussed. Twenty-six other cases of oral contraceptive-related mesenteric venous thrombosis reported in the English literature are reviewed.
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Affiliation(s)
- H A Hassan
- Division of Digestive Diseases and Nutrition, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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48
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Stein M, Link DP. Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 1999; 10:363-71. [PMID: 10102204 DOI: 10.1016/s1051-0443(99)70044-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years +/- 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months +/- 15.9. RESULTS Technical success of portal reconstruction was 85.7% (18 of 21). Thirty-day mortality was 14.3% (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2% +/- 13.5%, 63.5% +/- 15.3%, and 31.7% +/- 15.7%, respectively. Secondary patency was 79.1% +/- 13.8%. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.
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Affiliation(s)
- M Stein
- Department of Radiology, University of California Davis Medical Center, Sacramento, USA
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Schwartz DS, Gettner PA, Konstantino MM, Bartley CL, Keller MS, Ehrenkranz RA, Jacobs HC. Umbilical venous catheterization and the risk of portal vein thrombosis. J Pediatr 1997; 131:760-2. [PMID: 9403662 DOI: 10.1016/s0022-3476(97)70109-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Portal vein thrombosis has been associated with umbilical venous catheterization. We studied the incidence of portal vein thrombosis associated with umbilical venous catheterization with the catheter tip not in the portal venous system. Appropriate placement of an umbilical venous catheter in sick neonates is associated with a low risk of portal vein thrombosis (actual incidence, 1.3%).
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Affiliation(s)
- D S Schwartz
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA
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50
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Gürakan F, Koçak N, Yüce A, Ozen H. Extrahepatic portal venous obstruction in childhood: etiology, clinical and laboratory findings and prognosis of 34 patients. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:595-600. [PMID: 9363659 DOI: 10.1111/j.1442-200x.1997.tb03647.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Extrahepatic obstruction of the portal vein is a well known cause of portal hypertension in childhood, that causes severe morbidity. We evaluated 34 children (24 boys, 10 girls, age 4.5 months to 12 years, mean 5.5 +/- 3.8 years) with this diagnosis, to define the clinical picture, laboratory changes, diagnostic tools and therapeutic modalities. Gastrointestinal bleeding was the commonest mode of presentation (64.7%), with the second being splenomegaly. The cause of the obstruction could be determined in 38.2% (13/34) of the subjects. At the beginning of the study the main diagnostic procedure was splenoportography although in more recent years pulsed duplex Doppler ultrasonography has been used. The follow up period was median of 5 years (range 1-11 years). The mean number of bleeding episodes was 4.7 +/- 5.9 (range 1-26), while nine patients never bled. There was no mortality. Ten patients underwent surgery, while sclerotherapy was performed on 10. Twenty-one patients received beta-blocker drugs. No difference was found among these therapeutic modalities. It is well established that the major risk for children with extrahepatic portal vein obstruction is gastrointestinal bleeding which is tolerated quite well. Surgery should be indicated only in children where bleeding cannot be controlled by medical means including sclerotherapy.
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Affiliation(s)
- F Gürakan
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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