A case of two shunts in the endovascular treatment of type II Abernethy syndrome

Long-term follow-up and transcatheter embolization of extrahepatic congenital portosystemic shunt with shifting hemodynamics

Congenital portosystemic shunt (CPSS) is a rare vascular anomaly in which portal vein blood flows into the systemic circulation without passing through the liver. They occur in approximately 1 in 30,000-50,000 live births. We present an 11-year-old patient with an extrahepatic CPSS managed with long-term follow-up. The initial clinical presentation showed no significant abnormalities. Subsequent assessments revealed slightly elevated ammonia (NH3) and total bile acids (TBAs). Two times angiography at the ages of 2 and 11 years confirmed a shunt between the portal vein and left renal vein, with a gradual shift in blood flow dominance from the celiac artery-splenic vein system to the superior mesenteric artery-superior mesenteric vein system as the patient aged. Due to the risk of complications, transcatheter shunt embolization was performed, utilizing 12 coils to achieve complete shunt embolization. Post-embolization, NH3, and TBA levels normalized, and the patient remained asymptomatic. This case highlights the importance of timing in CPSS intervention, particularly with shifting hemodynamics and underscores the need for further studies on optimal intervention timing in pediatric CPSS.

A Rare Case of Childhood Malformations, Abernethy Syndrome: Literature Review and Presentation of Two Cases

Abernethy syndrome is a rare congenital vascular anomaly. In this condition, blood from the portal system is diverted to the caval system through a portocaval shunt, entirely or partially bypassing the liver. Prevalence figures in the literature range from 1 per 30000 population up to 1 per 50000 population. Abernethy syndrome is classified into 2 types based on the absence (type 1) or presence (type 2) of an intrahepatic portal vein. Abernethy syndrome can manifest with hepatic encephalopathy, pulmonary hypertension, severe osteoporosis, gastrointestinal bleeding, cirrhosis, hepatopulmonary syndrome, and abdominal pain. Hepatocellular carcinoma is a less common presentation. Type 1 Abernethy syndrome is usually treated with a liver transplant, whereas type 2 is addressed by closing the shunt either endovascularly or surgically. Here, we present cases to highlight that surgical shunt ligation is an effective treatment for type 2 Abernethy malformation when the shunt cannot be closed endovascularly.

Beyond the Rib Cage: Unraveling Abernethy Syndrome as a Rare Cause of Cyanosis

Abernethy syndrome is a rare congenital malformation stemming from a portosystemic shunt. Diagnosis proves challenging due to nonspecific clinical symptoms, with presentation varying based on age and disease severity. Consequences include hepatic, cardiovascular, renal, gastrointestinal, and neurological complications, and growth retardation. We report the case of a child presenting with perioral and digital cyanosis, observed in early childhood. Clinical examination revealed low saturation, telangiectasias, digital clubbing, and collateral venous circulation in the thorax. Imaging confirmed the diagnosis of Abernethy syndrome.

Case report: Rare abernethy malformation with hepatopulmonary syndrome in a pediatric patient

Abernethy malformation is a rare abnormality of the hepatic portal vein system with non-specific and diverse clinical manifestations. Here, we described a case of abernethy malformation with hepatopulmonary syndrome in a 10-year-old girl. On physical examination, cyanosed lips and acropachy could be found. Her oxygen saturation fluctuated at 89-94%, and the fasting blood ammonia was 98 umol/L. Furthermore, there were abnormalities in the imaging. The microbubble test with contrast echocardiography was positive. Computer tomography angiography (CTA) showed the splenic vein, and the superior mesenteric drained directly into the inferior vena cave after confluence. The same result was also observed in delayed splenic arteriography. Then, we discovered a tiny branch of the intrahepatic portal vein by the inferior vena cava balloon occlusion test, which could also show the confluence of the splenic vein and superior mesenteric vein with the inferior venacave. According to the evidence above, we concluded that the girl was a patient of type II abernethy malformation. For the severe dysplasia of the portal vein, the girl accepted partial ligation of portosystemic shunt and Rex shunt, which improved her oxygen saturation and exercise tolerance.