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Abbadi K, Shrateh ON, Musleh A, Asbah M, Khader A. Life-saving intervention following spontaneous rupture of splenic vein in a young patient: A case report and review of the literature. Int J Surg Case Rep 2023; 112:108952. [PMID: 37837664 PMCID: PMC10667775 DOI: 10.1016/j.ijscr.2023.108952] [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: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The spontaneous rupture of the splenic vein is indeed a rare occurrence, and it carries a high risk of mortality. To date, only a very limited number of documented cases of splenic vein rupture attributed to hepatic cirrhosis have been reported. CASE PRESENTATION A 17-year-old male patient was urgently referred to our hospital due to sudden severe abdominal pain. Upon admission, the patient displayed critical signs, including abdominal tenderness and shock. Lab results revealed low red blood cell count and elevated creatinine levels. A CT scan uncovered a substantial abdominal fluid accumulation and a ruptured splenic vein alongside a dilated superior mesenteric vein. Emergency exploratory surgery revealed extensive intraperitoneal bleeding due to the splenic vein rupture, leading to a total splenectomy and vein ligation. Surprisingly, histological findings confirmed liver cirrhosis, although the patient had shown no liver-related symptoms prior to surgery. Over six months of careful monitoring, the patient displayed significant improvement in health with no complications or readmissions. CLINICAL DISCUSSION The rupture of the splenic vein is an uncommon condition that should be taken into consideration when evaluating the potential causes of intra-abdominal hemorrhage, particularly in cirrhotic patients and pregnant women. The appropriate treatment typically involves controlling the hemorrhage and performing the ligation of the splenic vein, often necessitating an urgent splenectomy. CONCLUSION This case underscores the critical importance of considering uncommon sources of sudden intraperitoneal hemorrhage, such as splenic vein rupture. It also emphasizes the vital role of prompt surgical intervention in such cases.
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Affiliation(s)
- Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Abdellatif Khader
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine; Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
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Nitesh P, Biju P, Kalayarasan R. Superior Mesenteric Vein Aneurysm With Arteriovenous Communication and Portal Vein Thrombosis: A Rare Presentation in Non-cirrhotic Portal Hypertension. Cureus 2023; 15:e42595. [PMID: 37641745 PMCID: PMC10460496 DOI: 10.7759/cureus.42595] [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: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Visceral venous aneurysms are exceedingly rare clinical entities reported in the literature. Venous aneurysms are usually acquired in origin, with most often portal hypertension as the underlying pathology. Most venous aneurysms are incidental findings on imaging. Complications of venous aneurysms like rupture with catastrophic outcomes had been reported. However, no clear guidelines exist regarding the management of portal venous aneurysms as most of the data is available only from case reports. Here, we report a rare finding of fusiform superior mesenteric vein (SMV) aneurysm with arteriovenous communication and portal vein thrombosis in the background of non-cirrhotic portal hypertension.
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Affiliation(s)
- Pagadala Nitesh
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Pottakkat Biju
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Raja Kalayarasan
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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Kim HJ, Ha TY, Ko GY, Noh M, Kwon TW, Cho YP, Lee SG. A Case of Extrahepatic Portal Vein Aneurysm Complicated by Acute Thrombosis. Ann Vasc Surg 2017; 43:311.e9-311.e13. [DOI: 10.1016/j.avsg.2017.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
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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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Levi Sandri GB, Sulpice L, Rayar M, Bosquet E, Boudjema K, Meunier B. Extrahepatic Portal Vein Aneurysm. Ann Vasc Surg 2014; 28:1319.e5-7. [DOI: 10.1016/j.avsg.2013.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 11/20/2013] [Indexed: 11/25/2022]
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Labgaa I, Lachenal Y, Allemann P, Demartines N, Schäfer M. Giant extra-hepatic thrombosed portal vein aneurysm: a case report and review of the literature. World J Emerg Surg 2014; 9:35. [PMID: 24795777 PMCID: PMC4008416 DOI: 10.1186/1749-7922-9-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Extrahepatic Portal vein aneurysm (EPVA) is a rare finding that may be associated with different complications, e.g. thrombosis, rupture, portal hypertension and compression of adjacent structures. It is being diagnosed more frequently with the advent of modern cross-sectional imaging. Our review of the English literature disclosed 13 cases of thrombosed EPVA. CASE PRESENTATION A 50-years-old woman presented with acute abdominal pain but no other symptom. She had no relevant medical history. Palpation of the right upper quadrant showed tenderness. Laboratory tests were unremarkable. A computed tomography showed portal vein aneurysm measuring 88 × 65 mm with thrombosis extending to the superior mesenteric and splenic vein. The patient was treated conservatively with anticoagulation therapy. She was released after two weeks and followed on an outpatient basis. At two months, she reported decreased abdominal pain and her physical examination was normal. A computed tomography was performed showing a decreased thrombosis size and extent, measuring 80 × 55 mm. CONCLUSIONS Although rare, surgeons should be made aware of this entity. Complications are various. Conservative therapy should be chosen in first intent in most cases. We reported the case of the second largest thrombosed extra-hepatic PVA described in the literature, treated by anticoagulation therapy with a good clinical and radiological response.
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Affiliation(s)
- Ismaïl Labgaa
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Yann Lachenal
- Department of Radiology and Interventional Radiology, CHUV University Hospital, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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7
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Debernardi-Venon W, Stradella D, Ferruzzi G, Marchisio F, Elia C, Rizzetto M. Extrahepatic aneurysm of the portal venous system and portal hypertension. World J Hepatol 2013; 5:149-151. [PMID: 23556049 PMCID: PMC3612575 DOI: 10.4254/wjh.v5.i3.149] [Citation(s) in RCA: 6] [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: 11/17/2012] [Revised: 01/03/2013] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition’s pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.
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8
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Lall C, Verma S, Gulati R, Bhargava P. Portal vein aneurysm presenting with obstructive jaundice. J Clin Imaging Sci 2012; 2:54. [PMID: 23029637 PMCID: PMC3440936 DOI: 10.4103/2156-7514.100377] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/28/2012] [Indexed: 11/04/2022] Open
Abstract
To the best of our knowledge, a portal vein aneurysm presenting with obstructive jaundice has not been reported in the literature. The preferred treatment for these aneurysms is surgical and a shunting procedure should be considered in cases with portal hypertension to preserve portal vein flow when portal hypertension is present or is secondary to the aneurysm itself. In our case, due to patient's advanced age and co-morbidities, an endoscopic biliary stent was placed which led to successful resolution of symptoms of obstructive jaundice.
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Affiliation(s)
- Chandana Lall
- Abdominal Imaging, Clinical Radiology, University of California, Irvine, Orange CA, USA
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Fujikawa T, Tanaka A, Yoshimoto Y. Enlarged extrahepatic portal vein aneurysm in a non-cirrhotic patient: a therapeutic dilemma. BMJ Case Rep 2011; 2011:bcr.06.2011.4317. [PMID: 22675088 DOI: 10.1136/bcr.06.2011.4317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The authors report a case of a 75-year-old woman who was seen about 5 years ago and found to have asymptomatic gallstone and extrahepatic portal vein aneurysm (PVA) adjacent to the gallbladder. Further investigations revealed no evidence of cirrhosis. A follow-up ultrasound revealed that the PVA increased in diameter from 20 to 25 mm over 5 years and surgical intervention was recommended. Cholecystectomy and omental wrapping around PVA were performed. Postoperative follow-up investigations for 3 years revealed no increases in PVA diameter. Although PVA is clinically rare, the authors believe that their case report presents an overview of related literature, discusses indications for surgery in PVA and describes their surgical method for managing PVA.
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Affiliation(s)
- Takahisa Fujikawa
- Surgery Department, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
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10
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Ishimura K, Otani T, Wakabayashi H, Okano K, Goda F, Suzuki Y. A case report of extrahepatic portal vein aneurysm with thrombosis. World J Gastrointest Surg 2011; 3:39-42. [PMID: 30689677 PMCID: PMC3069337 DOI: 10.4240/wjgs.v3.i3.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 11/29/2010] [Accepted: 12/06/2010] [Indexed: 02/06/2023] Open
Abstract
Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases. Methods of treatment include resection, thrombectomy, and portal venous decompression. We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period. A PVA was detected in a 78-year-old woman by abdominal ultrasonography. Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis. Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm. Since the patient had no symptoms of portal hypertension, we decided to carefully manage her clinical course without surgical treatment. At present, this patient is healthy and has developed no complications over the 5 years since leaving our hospital. This case suggests that surgical treatment is not required for PVA without portal hypertension.
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Affiliation(s)
- Ken Ishimura
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
| | - Tsuyoshi Otani
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
| | - Hisao Wakabayashi
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
| | - Keiichi Okano
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
| | - Fuminori Goda
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
| | - Yasuyuki Suzuki
- Ken Ishimura, Tsuyoshi Otani, Hisao Wakabayashi, Department of Surgery, Kagawakensaiseikai Hospital, 1331-1 Tahikami, Takamatsu, Kagawa, 761-8076, Japan
- Keiichi Okano, Fuminori Goda, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, 761-0793, Japan
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11
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Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report. Case Rep Med 2010; 2010:560495. [PMID: 20593038 PMCID: PMC2892681 DOI: 10.1155/2010/560495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 04/28/2010] [Indexed: 12/29/2022] Open
Abstract
Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US), which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2 × 1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.
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12
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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: 4.9] [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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13
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Lorenzato MM, Granzotto E, Barros ADB, Silveira NZA, Souza PHRD. Aneurisma venoso na junção esplenomesentérica e emergência da veia porta: relato de caso. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os aneurismas no sistema esplenoportomesentérico são uma entidade clínica rara e de etiologia desconhecida, tendo como fatores contribuintes hipertensão portal, doença hepática crônica e trauma, entre outros. Os autores apresentam os achados de imagem de um caso de aneurisma na junção esplenomesentérica ao nível da emergência da veia porta, em uma paciente de 62 anos de idade sem fatores predisponentes.
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Affiliation(s)
- Mário Müller Lorenzato
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Documenta Clínica Radiológica, Brasil
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14
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Cho SW, Marsh JW, Fontes PA, Daily MF, Nalesnik M, Tublin M, De Vera ME, Geller DA, Gamblin TC. Extrahepatic portal vein aneurysm--report of six patients and review of the literature. J Gastrointest Surg 2008; 12:145-52. [PMID: 17851722 DOI: 10.1007/s11605-007-0313-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 08/16/2007] [Indexed: 01/31/2023]
Abstract
Extrahepatic portal vein aneurysm is a rare condition. We report six patients with extrahepatic portal vein aneurysm, four of whom were surgically treated. In addition, a review of the literature was performed to examine natural history, management, and outcomes regarding portal vein aneurysm. Patients seen at our institution with extrahepatic portal vein aneurysm greater than 1.9 cm in diameter were reviewed (1998 to 2006). There were five females and one male; median age was 66.5 (30-77). Computed tomography (CT) scan was utilized for diagnosis in all cases. The median diameter of the aneurysm was 4.7 cm (2.7-6.0). Indications for surgery included gallstone pancreatitis, mass effect on the adjacent duodenum, a peripancreatic mass, and liver cirrhosis. Three patients underwent aneurysm resection, and one patient had an orthotropic liver transplant. Two patients were managed with observation. The median follow-up from first presentation and surgery was 50 months (9-181) and 5 months (2-73), respectively. At last follow-up, five patients were alive with radiologically proven portal vein patency. One patient died 2 months after liver transplantation. There was no case of aneurysmal rupture. One patient had intramural thrombus at presentation that resolved with conservative treatment. This report suggests that symptomatic aneurysms can be safely resected with excellent patency.
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Affiliation(s)
- Sung W Cho
- Department of Surgery, UPMC Liver Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
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15
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De Gaetano AM, Andrisani MC, Gui B, Maresca G, Ionta R, Bonomo L. Thrombosed portal vein aneurysm. ACTA ACUST UNITED AC 2007; 31:545-8. [PMID: 17131206 DOI: 10.1007/s00261-005-0255-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We describe two cases of thrombosed extrahepatic portal vein aneurysms diagnosed by sonography, computed tomography, and magnetic resonance imaging. Portal vein aneurysm is a rare clinical entity that has been described as a focal dilatation that can affect intra- and extrahepatic portal branches. Although usually asymptomatic, thrombosis can lead to portal hypertension. Clinical and imaging characteristics are discussed, in addition to a review of the literature.
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Affiliation(s)
- A M De Gaetano
- Department of Radiology, A. Gemelli University Hospital, Rome, Italy.
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16
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Pey F, Bureau C, Otal P, Vinel JP, Rousseau H. Anomalies congénitales et acquises du système porte. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1155-1976(07)41406-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Wolff M, Schaefer N, Schmidt J, Hirner A. Thrombosis of a large portal vein aneurysm: treatment by thrombectomy, aneurysmorrhaphy, and portocaval shunt. J Gastrointest Surg 2006; 10:128-31. [PMID: 16368502 DOI: 10.1016/j.gassur.2005.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 04/06/2005] [Indexed: 01/31/2023]
Abstract
An otherwise healthy 32-year-old woman had unspecific upper abdominal complaints. Diagnostic work-up, including a helical computed tomography (CT) scan and indirect splenoportography, revealed a giant extrahepatic portal vein aneurysm (PVA) extending to the central part of the splenic vein. On laparotomy, a thrombectomy and creation of a portocaval side-to-side shunt were performed. Thirteen days later, she was readmitted for re-thrombosis of the aneurysm. She underwent another laparotomy with thrombectomy and tapering of the portal venous wall (aneurysmorrhaphy) by vascular staplers. On follow-up 25 months after the operation, full relief of symptoms was noted. She was on warfarin therapy. Her portal venous system was patent.
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Affiliation(s)
- Martin Wolff
- Department of Surgery, University of Bonn, Germany.
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18
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Giavroglou C, Xinou E, Fotiadis N. Congenital extrahepatic portal vein aneurysm. ACTA ACUST UNITED AC 2005; 31:241-4. [PMID: 16314993 DOI: 10.1007/s00261-005-0142-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/24/2005] [Indexed: 12/12/2022]
Abstract
Portal vein aneurysm is a rare clinical entity, with only 41 published cases in the English-language literature. Twenty-five of them were congenital. We present the case of a 50-year-old woman who was incidentally diagnosed with a congenital extrahepatic portal vein aneurysm during an investigation for dyspepsia. Ultrasonographic features are described with correlation of computed tomographic and magnetic resonance findings. Etiology, clinical significance, and management strategies for these lesions are discussed and a review of the literature regarding this entity is presented.
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Affiliation(s)
- C Giavroglou
- Department of Radiology, AHEPA Hospital, Aristotele University of Thessaloniki, 8, Pavlou Mela Street, Thessaloniki 54622, Greece.
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19
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Lazar J, Purandare D, Purandare N, Joshi M. Portal vein aneurysm causing obstructive jaundice. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cradex.2005.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jin B, Sun Y, Li YQ, Zhao YG, Lai CS, Feng XS, Wan CD. Extrahepatic portal vein aneurysm: Two case reports of surgical intervention. World J Gastroenterol 2005; 11:2206-9. [PMID: 15810096 PMCID: PMC4305799 DOI: 10.3748/wjg.v11.i14.2206] [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
We report two cases of extrahepatic portal vein aneurysm, and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splene-ctomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical interv-ention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.
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Affiliation(s)
- Bi Jin
- Department of Vascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
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21
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Alexopoulou A, Papanikolopoulos K, Thanos L, Dourakis SP. Aneurysmal dilatation of the portal vein: a rare cause of portal hypertension. Scand J Gastroenterol 2005; 40:233-5. [PMID: 15764157 DOI: 10.1080/00365520410009474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aneurysmal dilatation of the portal vein (ADPV) is a rare cause of portal hypertension. We described a case of ADPV in a female patient who presented with ascites. Imaging studies revealed tortuosity and dilatation of the main portal vein with turbulent flow. Endoscopy revealed oesophageal varices. A liver biopsy showed no abnormalities in liver histology. This is the first case of ascites as a complication of ADPV in the absence of liver cirrhosis, arteriovenous fistula or documented portal vein thrombosis. Hyperdynamic circulation and increased portal vein flow could be implicated in the pathogenesis of ascites in this setting.
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22
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Kim J, Kim MJ, Song SY, Kim JH, Lim JS, Oh YT, Kim KW. Acute thrombosis of a portal vein aneurysm and development. Clin Radiol 2004; 59:631-3. [PMID: 15208071 DOI: 10.1016/j.crad.2003.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- J Kim
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
BACKGROUND A large aneurysm of the main portal vein is rare, and the appropriate surgical procedure is uncertain. Reconstruction of a main portal vein affected by a large saccular aneurysm is described. CASE OUTLINE Abdominal pain led to the diagnosis of a large saccular aneurysm of the main portal vein in a 58-year-old woman who had undergone cholecystectomy 10 years earlier. At laparotomy a dorsolateral approach to the hepatoduodenal ligament was performed with no attempt at extensive separate exposure of the anatomical structures in the hepatoduodenal ligament, so as to avoid the devascularisation of the common hepatic duct and additional weakening of the portal vein wall. The aneurysm was longitudinally incised, and the portal vein was reconstructed from the walls of the aneurysm with a longitudinal running suture. The rest of the aneurysmal wall was wrapped around the portal vein, leaving it normal in size and contour. Recovery was uneventful. Follow-up CT scan showed a patent portal vein in the region of the former aneurysm. DISCUSSION Large saccular aneurysms can rupture, bleed and cause death. The potential hazards of manipulation of large portal vein aneurysms are negligible in comparison with the possible complications of the aneurysm itself. In our opinion the ease with which the main portal vein was dissected and reconstructed make an elective operation in such cases a reasonable approach.
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Affiliation(s)
- Vojko Flis
- Department of Vascular Surgery, Teaching Hospital MariborMariborSlovenia
| | - Eldar Gadžijev
- Department of Abdominal Surgery, Teaching Hospital MariborMariborSlovenia
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25
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Santana P, Jeffrey RB, Bastidas A. Acute thrombosis of a giant portal venous aneurysm: value of color Doppler sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:701-704. [PMID: 12054311 DOI: 10.7863/jum.2002.21.6.701] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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26
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Bernal C, Ocaña J, Gandarias C, Haurie J, Perera M, Osorio A, Gallo P, Mendieta C, Utrilla A, Aracil E, Chinchilla A, Cuesta C. Aneurismas de la vena esplénica. A propósito de un caso y revisión de la literatura. ANGIOLOGIA 2001. [DOI: 10.1016/s0003-3170(01)74674-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Nangou P, Bertrand P, Samann I, Filali A, el Hassani R, Benabdellah C, Elhadj R, Boulakia C, Icard P. [Portal vein aneurysm]. ANNALES DE CHIRURGIE 2000; 125:476-8. [PMID: 10925492 DOI: 10.1016/s0001-4001(00)00156-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a 72-year-old female patient suffering from non specific and vague abdominal pain, an aneurysm of the portal vein was discovered. In the absence of complication, and because the risk of operation appeared too high, the decision was to abstain from surgery. With more than 3 years of regular follow-up, the patient was free of symptoms, and the portal vein aneurysm was unchanged. Sixty cases including this one are reviewed.
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Affiliation(s)
- P Nangou
- Service de chirurgie viscérale et vasculaire, centre hospitalier d'Auxerre, France
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28
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Abstract
Splenic vein aneurysms are rare and are usually caused by portal hypertension. Symptoms are unusual, but may include rupture or abdominal pain. Diagnosis can usually be made either by means of duplex ultrasonography or computed tomography scanning. Treatment varies from noninvasive follow-up to aneurysm excision. We report an expanding splenic vein aneurysm in a young woman with abdominal and back pain and no history of portal hypertension. She was treated with aneurysm excision and splenectomy.
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Affiliation(s)
- G Torres
- Division of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, USA
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29
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Altuntaş B, Erden A, Karakurt C, Kut A, Senbil N, Yurdakul M. Severe portal hypertension due to congenital hepatoportal arteriovenous fistula associated with intrahepatic portal vein aneurysm. JOURNAL OF CLINICAL ULTRASOUND : JCU 1998; 26:357-360. [PMID: 9719986 DOI: 10.1002/(sici)1097-0096(199809)26:7<357::aid-jcu6>3.0.co;2-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 13-year-old girl was referred for assessment of severe gastrointestinal tract bleeding. Her liver function tests were normal, and she had no evidence of chronic liver disease or history of significant trauma. Clinical and sonographic findings suggested the presence of a portal vein aneurysm associated with a hepatoportal arteriovenous fistula. Abdominal angiography confirmed the diagnosis. The arteriovenous fistula was congenital, and the associated portal vein aneurysm was either congenital or secondary to hemodynamic changes in the portal venous system.
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Affiliation(s)
- B Altuntaş
- Dr. Sami Ulus Children's Hospital, Ankara, Turkey
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30
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Brock PA, Jordan PH, Barth MH, Rose AG. Portal vein aneurysm: a rare but important vascular condition. Surgery 1997; 121:105-8. [PMID: 9001559 DOI: 10.1016/s0039-6060(97)90190-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P A Brock
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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31
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Abstract
The case of a 50-year-old woman with an extremely rare venous malformation of the portal venous system is reported. The patient presented with a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. This malformation may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. Aneurysms of the portomesenteric venous system may be asymptomatic or give rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to portal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be helpful in confirming it. In our opinion aneurysms of the portal venous system, even if they are congenital and (still) asymptomatic, require early surgical control because the prognosis for patients with these aneurysms is unpredictable and potential complications (e.g., portal hypertension, fistula, contained perforation, or rupture) may be fatal. In the case presented the mesenteric venous aneurysm was resected and the confluent veins were reconstructed.
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Affiliation(s)
- R Lerch
- Department of Vascular and Thoracic Surgery, Zentralklinikum Augsburg, Germany
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32
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Castor BK, Dahnert W. Extrahepa tic Portal Vein Aneurysm. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1996. [DOI: 10.1177/857647939601200209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The following is a case report of an 80-year-old woman, who, to the authors' knowldge, is the oldest reported patient to have an extrahepatic portal vein aneurysm. As in this patient, most findings of this rare lesion are incidental. The authors made the presumptive diagnosis of a congenital etrrahepatic portal vein aneurysm based on the location, the absence of underlying lier, pancreatic, biliary duct, gall bladder disease, or any other apparent cause. Gray scale and color duplex sonography were used to make the diagnosis in this case.
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Affiliation(s)
- Barbara K. Castor
- Good Samaritan Regional Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006
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Calligaro KD, Ahmad S, Dandora R, Dougherty MJ, Savarese RP, Doerr KJ, McAffee S, DeLaurentis DA. Venous aneurysms: surgical indications and review of the literature. Surgery 1995; 117:1-6. [PMID: 7809821 DOI: 10.1016/s0039-6060(05)80222-3] [Citation(s) in RCA: 225] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND During the last 20 years we diagnosed five cases of venous aneurysm of the jugular (n = 4) and basilic (n = 1) veins. The purpose of this report was to determine the natural history and indications for surgery of venous aneurysms. METHODS Our five cases were included in an English-language literature review performed through August 1993. RESULTS In our series two aneurysms (one external jugular vein, one basilic vein) were excised for cosmetic reasons. Three internal jugular vein aneurysms were followed up for up to 4 years without complications with serial color duplex ultrasonography. Of 32 patients with abdominal venous aneurysms (18 portal, seven inferior vena cava, four superior mesenteric, two splenic, one internal iliac), 13 (41%) had major complications including five deaths. Of 31 patients with deep venous aneurysms of the extremity (29 popliteal, two common femoral), 22 (71%) had deep vein thrombosis or pulmonary embolism and in 17 recurrent deep vein thrombosis or pulmonary embolism developed when patients were treated with anticoagulation alone. CONCLUSIONS Prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for most patients with lower extremity deep venous aneurysms. Other venous aneurysms should be excised only if they are symptomatic, enlarging, or disfiguring.
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Affiliation(s)
- K D Calligaro
- Section of Vascular Surgery, Pennsylvania Hospital/University of Pennsylvania School of Medicine, Philadelphia
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Ohhira M, Ono M, Ohhira M, Matsumoto A, Ohta H, Namiki M. Case report: splenic vein aneurysm--report of a lesion that progressively expanded. Br J Radiol 1994; 67:656-8. [PMID: 8062003 DOI: 10.1259/0007-1285-67-799-656] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A case of splenic vein aneurysm is reported. The patient was diagnosed as having a cirrhotic liver with portal hypertension. Computed tomography and angiography demonstrated a splenic vein aneurysm with saccular dilatation. The splenic vein aneurysm increased in size as the hepatic cirrhosis deteriorated; however, there were no complications such as rupture or thrombosis. To our knowledge this is the first report describing the development of a portal system aneurysm.
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Affiliation(s)
- M Ohhira
- Department of Internal Medicine III, Asahikawa Medical College, Japan
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