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Priadko K, Romano M, Vitale LM, Niosi M, De Sio I. Asymptomatic portal vein aneurysm: Three case reports. World J Hepatol 2021; 13:515-521. [PMID: 33959231 PMCID: PMC8080547 DOI: 10.4254/wjh.v13.i4.515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Portal vein aneurysm (PVA) is an uncommon vascular dilatation, showing no clear trend in sex or age predominance. Due to the low number of published cases and the lack of management guidelines, treatment of this condition remains a clinical challenge.
CASE SUMMARY We present three cases of asymptomatic PVA; the first and second involve an extrahepatic manifestation, of 48 mm and 42.3 mm diameter respectively, and the third involves an intrahepatic PVA of 27 mm. All were diagnosed incidentally during routine check-up, upon ultrasonography scan. Since all patients were asymptomatic, a conservative treatment strategy was chosen. Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.
CONCLUSION As PVA remains asymptomatic in many cases, recognition of its imaging features is key to favourable outcomes.
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Affiliation(s)
- Kateryna Priadko
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Marco Romano
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Luigi Maria Vitale
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Marco Niosi
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Ilario De Sio
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
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Lin J, Wang J, Yue P, Zhang X, Lang R, Wang Y, Cui C, He Q. Treatment and outcome of intestinal perforation after liver transplant surgery in adults: a single-center experience. Ther Clin Risk Manag 2017; 13:675-678. [PMID: 28615946 PMCID: PMC5460651 DOI: 10.2147/tcrm.s137161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Intestinal perforation is a rare complication after liver transplantation. This study was designed to calculate the incidence and investigate the outcomes of intestinal perforation in adult liver transplant patients. MATERIALS AND METHODS The clinical records of liver transplant recipients between January 2014 and June 2016 were obtained. The incidence of intestinal perforation was calculated, and high risk factors were analyzed. RESULTS The mean operative time was 8.5 h (range: 6-11 h). The mean portal vein occlusion time was 66.5 min (range: 58-72 min), and the mean cold ischemia time was 7.9 h (range: 6.5-9.5 h). Four (2.7%) patients developed intestinal perforation from 9 to 14 days postliver transplant. All perforations were single and repaired by interrupted silk sutures. Two patients uneventfully recovered, but intestinal perforation recurred in two other patients. Simple repair was undertaken in one patient, and terminal ileum resection and ileostomy were performed in the other patient. There were no perioperative deaths. CONCLUSION The incidence of intestinal perforation after liver transplantation is low. Prompt diagnosis and treatment should be carried out to reduce comorbidities and mortality.
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Affiliation(s)
| | - Jing Wang
- Patient Service Center, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital
| | - Peng Yue
- School of Nursing, Department of Basic Nursing, Capital Medical University
| | - Xingmao Zhang
- Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People's Republic of China
| | - Ren Lang
- Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People's Republic of China
| | - Yuan Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People's Republic of China
| | - Chen Cui
- Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People's Republic of China
| | - Qiang He
- Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People's Republic of China
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3
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Abstract
Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956 and since then less than 200 cases have been reported. The aim of this article is to provide an overview of the international literature to better clarify various aspects of this rare nosological entity and provide clear evidence-based summary, when available, of the clinical and surgical management. A systematic literature search of the Pubmed database was performed for all articles related to portal vein aneurysm. All articles published from 1956 to 2014 were examined for a total of 96 reports, including 190 patients. Portal vein aneurysm is defined as a portal vein diameter exceeding 1.9 cm in cirrhotic patients and 1.5 cm in normal livers. It can be congenital or acquired and portal hypertension represents the main cause of the acquired version. Surgical indication is considered in case of rupture, thrombosis or symptomatic aneurysms. Aneurysmectomy and aneurysmorrhaphy are considered in patients with normal liver, while shunt procedures or liver transplantation are the treatment of choice in case of portal hypertension. Being such a rare vascular entity its management should be reserved to high-volume tertiary hepato-biliary centres.
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Quan JR, Lu Q, Ling WW, Luo Y. Extrahepatic portal vein aneurysm after orthotopic liver transplantation: a case with 9-year ultrasound observations. J Med Ultrason (2001) 2012; 39:271-4. [PMID: 27279116 DOI: 10.1007/s10396-012-0368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 06/02/2011] [Indexed: 02/05/2023]
Abstract
We report a case of extrahepatic portal vein aneurysm (PVA) in the late postoperative period after orthotopic liver transplantation (OLT). A 46-year-old man underwent OLT in 2001 for treatment of hepatitis B virus-induced cirrhosis and received ultrasound follow-up for 9 years. The long-term ultrasound observations showed that the diameter of the main portal vein had progressively increased from 12 mm in 2001 to 34 mm in 2007, and then remained at 34 mm from 2007 to 2010. The patient did not show any symptoms or complications that required surgical treatment during the clinical follow-up. Our case suggests that PVA after OLT can remain without a sign of deterioration for a long time, and careful observation by ultrasound may be one of the options in the clinical management.
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Affiliation(s)
- Jie Rong Quan
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Wen Wu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
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5
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Schwope RB, Margolis DJ, Raman SS, Kadell BM. Portal vein aneurysms: a case series with literature review. J Radiol Case Rep 2010; 4:28-38. [PMID: 22470738 DOI: 10.3941/jrcr.v4i6.431] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Portal vein aneurysms are a relatively uncommon entity and often an incidental, asymptomatic finding. Recognition of this finding can help to avoid potential confusion with abdominal masses of other etiologies. We would like to present four cases of portal vein aneurysms, and discuss the natural history, imaging findings, and treatment of this condition. One of the cases of portal vein aneurysm presented occurred after liver transplantation, which, to the best of our knowledge, has only been described once in the English-language literature.
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Affiliation(s)
- Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Francesco FD, Gruttadauria S, Caruso S, Gridelli B. Huge extrahepatic portal vein aneurysm as a late complication of liver transplantation. World J Hepatol 2010; 2:201-2. [PMID: 21160997 PMCID: PMC2999282 DOI: 10.4254/wjh.v2.i5.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/30/2010] [Accepted: 04/06/2010] [Indexed: 02/06/2023] Open
Abstract
A 60-year-old male underwent orthotopic liver transplantation because of hepatitis C virus related cirrhosis. After 12 d, the patient underwent re-transplantation due to primary graft non function. One year later the patient developed a thrombosis of the main portal vein needing a surgical revision. After 11 years the patient was operated on because of a clinical picture of intestinal occlusion. As an incidental finding, a large aneurysm of the main portal vein was diagnosed. The incidence of intra- and extrahepatic Portal vein aneurysms (PVAs) is not clear. To the best of our knowledge, only one case of intrahepatic PVA in a liver transplant has been reported in the literature. In addition, we have found no documented cases of extrahepatic PVAs in liver transplanted patients.
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Affiliation(s)
- Fabrizio di Francesco
- Fabrizio di Francesco, Salvatore Gruttadauria, Settimo Caruso, Bruno Gridelli, Mediterranean Institute for Transplant and Advanced Specialized Therapies, University of Pittsburgh Medical Center, Palermo 90127, Italy
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Sfyroeras GS, Antoniou GA, Drakou AA, Karathanos C, Giannoukas AD. Visceral venous aneurysms: clinical presentation, natural history and their management: a systematic review. Eur J Vasc Endovasc Surg 2009; 38:498-505. [PMID: 19560947 DOI: 10.1016/j.ejvs.2009.05.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 05/26/2009] [Indexed: 02/05/2023]
Abstract
AIM Aneurysms of the visceral veins are considered rare clinical entities. The aim is to assess their clinical presentation, natural history and management. METHODS An electronic search of the pertinent English and French literature was undertaken. All studies reporting on aneurysms of visceral veins were considered. Cases describing patients with arterial-venous fistulae and extrahepatic or intra-hepatic portosystemic venous shunts were excluded. RESULTS Ninety-three reports were identified, including 176 patients with 198 visceral venous aneurysms. Patients' age ranges from 0 to 87 years, and there is no apparent male/female preponderance. The commonest location of visceral venous aneurysms is the portal venous system (87 of 93 reports, 170 of 176 patients, 191 of 198 aneurysms). Aneurysms of the renal veins and inferior mesenteric vein are also described. Portal system venous aneurysms were present with abdominal pain in 44.7% of the patients, gastrointestinal bleeding in 7.3%, and are asymptomatic in 38.2%. Portal hypertension is reported in 30.8% and liver cirrhosis in 28.3%. Thrombosis occurred in 13.6% and rupture in 2.2% of the patients. Adjacent organ compression is reported in 2.2% (organs compressed: common bile duct, duodenum, inferior vena cava). The management ranged from watchful waiting to intervention. In 94% of the cases, aneurysm diameter remained stable and no complications occurred during follow-up. In most of the cases, indications for operation were symptoms and complications. Six cases of renal vein aneurysm are reported; three of them were asymptomatic. Three of these patients were treated surgically. CONCLUSION The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare.
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Affiliation(s)
- G S Sfyroeras
- Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece
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Abstract
Transplantation has become the method of choice for treatment of patients with irreversible severe liver dysfunction. Vascular thrombosis or stenosis, biliary obstruction, hemorrhage, posttransplantation neoplasm, and rejection are some of the most common potential complications. Most complications cause significant morbidity and mortality after liver transplantation. The appearance of vascular complications in posttransplantation patients is illustrated in this article.
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Ho CM, Tsai SF, Lin RK, Liang PC, Sheu TWH, Hu RH, Lee PH. Computer Simulation of Hemodynamic Changes After Right Lobectomy in a Liver with Intrahepatic Portal Vein Aneurysm. J Formos Med Assoc 2007; 106:617-23. [PMID: 17711794 DOI: 10.1016/s0929-6646(08)60018-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Intrahepatic portal vein aneurysm is rare and its natural history is unknown. A 22-year-old healthy man, who wished to donate part of his liver to his diseased father, was incidentally diagnosed to have an intrahepatic portal vein aneurysm. The surgical decision of performing live donor hepatectomy for such a patient is normally difficult. We combined modern imaging reconstruction technologies with scientific computing as a new modality to foresee the risks of surgical complications. METHODS Cross-sectional computed tomography images were used to reconstruct the three-dimensional image of portal vein distribution using the 3D-Doctor v3.5 software. The reconstructed images were further employed to generate surface and interior meshes with CFX software. Simulated hemodynamic changes in velocity, pressure, and wall stress were determined for the right lobectomy case pre- and postoperatively. RESULTS The simulation results indicated that aneurismal pressure would be elevated significantly to 12.03 mmHg after operation. The left segmental portal venous blood flow would increase from 2.95- to 4.25-fold. The area near the branch point of one left segmental portal vein, which supplies blood to liver segment 4, and the portal vein aneurysm would endure high shear stress gradient. The resulting elevated aneurismal pressure may cause the thin wall to enlarge and rupture, while the high shear stress gradient would lead to vascular endothelial cell injury. Living donor surgery was not recommended hemodynamically based on the simulated results. CONCLUSION Scientific computing and modern imaging technologies can be applied together to aid surgeons to make the best decision in difficult clinical situations.
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Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
AIM: To describe cases of gut perforation after orthotopic liver transplantation.
METHODS: Data were colleted from our center database and medical records. Six of 187 patients (3.2%) who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation. All patients were male with an average age of 46 years. Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University.
RESULTS: Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min (range 45-72 min), median cold ischaemia time was 11.3 h (range 7-15 h). Median intraoperative blood loss was 500 mL (range 100-1200 mL) and median operation time was 8.8 h (range 6-12 h). None of the six patients developed acute cellular rejection. White cell count was above 18 × 109/L in five patients (neutrophilic leukocytes were above 90%) and 1.5 × 109/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation.
CONCLUSION: Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis, preferably through detection of enterococci may ensure better survival.
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Affiliation(s)
- Jun Xiong
- Organ Transplantation Center, 1st Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
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