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Chandran S, Kumar M, Jacob TJK, Mohamed F. Intestinal obstruction with a twist: a rare case of congenital portal vein aneurysm causing intestinal obstruction. BMJ Case Rep 2018; 2018:bcr-2018-225689. [PMID: 30244223 DOI: 10.1136/bcr-2018-225689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bilious vomiting is often a presenting feature of upper intestinal obstruction in newborn. We present a case of intestinal obstruction in a newborn baby caused by abnormal vascular band arising from portal vein aneurysm in association with a midgut volvulus. Congenital anomalies of portovenous system are very rare, and it usually presents with portal hypertension in late infancy or childhood. In this particular child, the portal vein aneurysm contributed to intestinal obstruction due to both a failure of intestinal rotation and a mechanical band over the transverse colon.
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Affiliation(s)
- Shanu Chandran
- Department of Neonatology, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Tarun John K Jacob
- Department of Pediatric surgery, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Ferzine Mohamed
- Department of Pediatric surgery, Christian Medical College and Hospital, Vellore, Tamilnadu, India
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Sun J, Sun CK, Sun CK. Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery. Case Rep Gastroenterol 2018; 12:570-577. [PMID: 30323732 PMCID: PMC6180260 DOI: 10.1159/000492812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/09/2018] [Indexed: 12/28/2022] Open
Abstract
Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.
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Affiliation(s)
- Jeffrey Sun
- School of Medicine, Imperial College London, London, United Kingdom
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan
| | - Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Long-Term Care, University of Kang Ning, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.,School of Medicine, Taipei Medical University, Taipei, Taiwan
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Hirji SA, Robertson FC, Casillas S, McPhee JT, Gupta N, Martin MC, Raffetto JD. Asymptomatic portal vein aneurysms: To treat, or not to treat? Phlebology 2017; 33:513-516. [PMID: 28950753 DOI: 10.1177/0268355517733375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. Conclusion Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts.
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Affiliation(s)
- Sameer A Hirji
- 1 Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Faith C Robertson
- 1 Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sergio Casillas
- 2 Division of Vascular Surgery, Boston Medical Center, Boston, MA, USA
| | - James T McPhee
- 2 Division of Vascular Surgery, Boston Medical Center, Boston, MA, USA.,3 Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - Naren Gupta
- 2 Division of Vascular Surgery, Boston Medical Center, Boston, MA, USA.,3 Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - Michelle C Martin
- 2 Division of Vascular Surgery, Boston Medical Center, Boston, MA, USA.,3 Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - Joseph D Raffetto
- 1 Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,3 Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, West Roxbury, MA, USA
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Augusto R, Gouveia R, Sousa P, Campos J, Coelho A, Brandão D, Canedo A. Aneurisma da veia porta. ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Portal vein aneurysms are rare vascular abnormalities, many of which are incidentally discovered on routine imaging studies. The etiology of portal venous aneurysms is poorly understood, and the management of these lesions is debatable. We report the case of a 61-year-old woman with extrahepatic portal vein aneurysm. We review the nature and significance of this abnormality and discuss appropriate clinical, imaging, and treatment approaches.
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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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Bertocchini A, d'Ambrosio G, Grimaldi C, del Prete L, di Francesco F, Falappa P, Monti L, de Ville de Goyet J. Prehepatic portal hypertension with aneurysm of the portal vein: unusual but treatable malformative pattern. J Pediatr Surg 2014; 49:436-40. [PMID: 24650473 DOI: 10.1016/j.jpedsurg.2013.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Portal vein aneurysms (PVAs) are usually located at the vein trunk or at its bifurcation, rarely intra-hepatic, or at the umbilical portion. Etiology remains unclear. METHODS Three children with PVA were identified over a 5-year period. PVA anatomy was assessed by Doppler Ultrasound, Angio CT/MRI, and trans-jugular retrograde portography. RESULTS Three children with intrahepatic PVA (including the umbilical portion) were identified during assessment for pre-hepatic portal hypertension: all had splenomegaly and hypersplenism. One presented with massive variceal bleeding. In two cases, a portal vein cavernoma was found, and in the third a severe stricture at the portal bifurcation was observed. Restoration of portal venous flow was achieved by a meso-Rex bypass in two cases and transposing the PV into the Rex in one. High hepatopetal portal flow was restored immediately, with follow-up confirming long-term patency and resolution of signs of portal hypertension with time. CONCLUSIONS These original observations suggest a common initial malformative pattern consisting of a portal venous stricture/web causing a post-stenotic aneurysmal dilatation of the intrahepatic portal branches complicated by thrombosis and cavernomatous transformation of the portal vein trunk. Importantly, the Meso-Rex bypass allows restoring a normal portal flow and cures the portal hypertension.
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Affiliation(s)
- Arianna Bertocchini
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy.
| | - Giuseppe d'Ambrosio
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Chiara Grimaldi
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Laura del Prete
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Fabrizio di Francesco
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Piergiorgio Falappa
- Interventional Radiology Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Lidia Monti
- Hepato-biliary Radiology Unit, Department of Imaging, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Jean de Ville de Goyet
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
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Imaging features and follow-up of large extrahepatic portal vein aneurysm. J Vasc Surg Venous Lymphat Disord 2013; 1:309-10. [PMID: 26992593 DOI: 10.1016/j.jvsv.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 06/19/2012] [Accepted: 07/10/2012] [Indexed: 11/22/2022]
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Affiliation(s)
- Ashraf Haddad
- Department of Surgery St. Agnes Hospital Baltimore, Maryland
| | - Mark Fraiman
- Department of Surgery St. Agnes Hospital Baltimore, Maryland
| | - Richard Mackey
- Department of Surgery St. Agnes Hospital Baltimore, Maryland
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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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Wallis A, Rogers T, Pope I, Callaway M. Blunt abdominal trauma - An important cause of portal venous pseuodoaneurysm. J Radiol Case Rep 2010; 4:27-31. [PMID: 22470731 DOI: 10.3941/jrcr.v4i5.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aneurysms and pseudoaneurysms of the portal venous system are rarely seen following abdominal trauma but clinicians need to be aware of them as possible vascular complications following blunt trauma. This case report of a 10 year old boy following a handlebar injury demonstrates a clear causal relationship between trauma and portal venous pseudoaneurysm. Portal venous aneurysms have a prevalence of less than 0.4% and most are found in patients with underlying hepatocellular disease. Many are asymptomatic in which case surveillance is an accepted management strategy, with Doppler ultrasound proving useful. Complications including thrombosis, distal embolism, compression of the biliary tree and haemorrhage are usually indications for surgical management. Portal venous pseudoaneurysms may be managed conservatively but transcatheter embolisation can be used if there are ongoing complications or haemorrhage.
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Affiliation(s)
- Adam Wallis
- Department of Clinical Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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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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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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Mucenic M. Review. Gastroenterol Hepatol (N Y) 2007; 3:299-300. [PMID: 21960845 PMCID: PMC3099280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Marcos Mucenic
- Liver Transplant Group, Hospital Santa Casa de Misericordia, Brazil
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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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