Successful management of an Iatrogenic portal vein and hepatic artery injury in a 4-month-old female patient: A case report and literature review

Serious iatrogenic vascular injuries are considered uncommon; however, they are underreported. There are limited studies discussing the proper management of these injuries; therefore, the management is often anecdotal. A 4-month-old female patient presented with elevated liver enzymes and cholecystitis with sludge. Her HIDA scan suggested biliary atresia. During the surgery, there was a bilateral iatrogenic injury to the hepato-duodenal ligament, including the portal vein, hepatic artery, and bile ducts. The patient underwent splenectomy and cholecystectomy, and the hepatic artery transection was successfully managed with a splenic artery jump graft and a portal vein bypass initiated with the SMV using a Gore-TexⓇ vascular graft. The management of iatrogenic vascular injury depends primarily on the assessment of the stage of the injury, which should be conducted by experienced surgeons using proper strategies in an established hepato-biliary surgical center. Additionally, there is little data provided in the literature, mostly case reports. Therefore, no preferred or specific approach can be found.

A rare delayed onset of esophageal varices and portal vein thrombosis in a ten-year-old patient following umbilical vein catheterization

Introduction and significance

Portal vein thrombosis (PVT) is not commonly observed in patients, particularly those who have gone through neonatal intensive care unit (NICU) stays and had umbilical catheters. Although PVT can potentially cause hypertension and gastrointestinal bleeding it is highly unusual for this condition to manifest during childhood.

Case presentation

The authors present a case of a 10-year-old child who developed portal hypertension, esophageal varices, and multiple thrombophilia associated mutations. This child was born prematurely. Had to stay in the NICU, where an umbilical venous catheter was used which likely triggered the development of PVT. At the age of 7 he started experiencing distension, anemia and low platelet count, which eventually led to splenectomy. On at the age of 10 he began experiencing episodes of bleeding. Was diagnosed with esophageal varices and portal gastropathy. Through procedures, like Histoacryl glue injection and band ligation bleeding was successfully controlled. Genetic analysis revealed mutations associated with thrombophilia.

Clinical discussion

This case highlights how rare it is for older children to develop PVT and emphasizes the possibility of delayed onset symptoms following catheterization. The placement of catheters in NICUs can disrupt blood flow and increase the likelihood of clot formation. The presence of hypertension resulting from PVT can lead to complications such as varices. Effective control, over bleeding was achieved through interventions.Importantly, the presence of ACE I/D, FXIII Val34Leu, and Factor V Leiden mutations introduces an aspect to this scenario. It is worth noting that these mutations are not commonly linked to thrombophilia or clotting disorders.

Conclusion

This case highlights pediatric PVT, emphasizing the need for a collaborative approach among gastroenterologists, hematologists, and geneticists. Further research is required to understand PVT mechanisms and long-term implications, aiding in diagnosis and management, especially when it appears in late childhood. Evaluation is crucial in deciphering thrombophilia-related complications in the context of hypertension.

Splenic infarction secondary to polycythemia Vera: Case report and literature review

Splenic infarction is a medical condition characterized by compromised blood flow to the spleen, resulting in partial or complete organ infarction. This condition is commonly observed in patients with an increased risk of thrombosis, such as those with Polycythemia Vera (PV). A 40-year-old female patient presented with fatigue, weakness, and an enlarged spleen, further tests revealed elevated levels of hemoglobin, white blood cells, and platelets. A bone marrow biopsy and positive Jack II mutations confirmed the diagnosis of PV. The patient later developed portal hypertension, varices, and splenic infarction. This case report aims to raise awareness about the potential complications of PV and emphasizes the importance of early intervention to prevent serious consequences such as splenic infarction. Additionally, it highlights the role of splenectomy in managing complications associated with PV.

An unusual case of chronic mesenteric ischemia: Case report

Chronic mesenteric ischemia (CMI) is a rare cause of abdominal pain with risk factors as Diabetes, Hypertension, smoking and age above 65-year-old age. A 55 -year-old man, a heavy smoker, with no other risk factor for chronic mesenteric ischemia, presented with a recurrent episodes of abdominal pain. Many differential diagnoses were excluded, CT angiography was showed Inferior Mesenteric artery (IMA) and superior Mesenteric artery (SMA) stenosis, then the Intervention was done successful. Gastric ulcers that are resistant to treatment, H. pylori negative and with no history of non-steroidal anti-inflammatory drugs (NSAID) use should be investigated for a possible ischemic.