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Extrahepatic portal vein obstruction

Shumyla Jabeen, Irfan Robbani, Naseer A Choh, Obaid Ashraf, Feroze Shaheen, Tariq Gojwari, Sabeeha Gul
OBJECTIVE: To characterize biliary abnormalities seen in portal cavernoma cholangiopathy (PCC) on Magnetic Resonance Cholangiopancreaticography(MRCP) and elucidate certain salient features of the disease by collaborating our findings with those of previous studies. METHODS: We prospectively enrolled 52 patients with portal cavernoma secondary to idiopathic Extrahepatic portal vein obstruction(EHPVO) who underwent a standard MRCP protocol. Images were analysed for abnormalities involving the entire biliary tree...
October 12, 2016: British Journal of Radiology
Azho Kezo, Rajendra D Patel, Shraddha Mathkar, Sonal Butada
BACKGROUND: We report the management of two patents from the Indian subcontinent with extrahepatic portal vein obstruction presenting with anticipated difficult airway. A Macintosh blade was used to secure the airway after using various instruments designed for difficult airway. To the best of our knowledge, no case has previously been reported in which a Macintosh blade was used successfully in patients with extrahepatic portal vein obstruction with a difficult airway. CASE PRESENTATION: Two women (case 1 and case 2) of South Asian ethnicity with extrahepatic portal vein obstruction presented for an elective splenorenal shunt...
2016: Journal of Medical Case Reports
Parisá Khodayar-Pardo, Andrés Peña Aldea, Ana Ramírez González, Adela Meseguer Carrascosa, Cristina Calabuig Bayo
Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound...
May 2016: Case Reports in Gastroenterology
Sudheer S Pargewar, Saloni N Desai, S Rajesh, Vaibhav P Singh, Ankur Arora, Amar Mukund
Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late...
June 28, 2016: World Journal of Radiology
Sid Ahmed Faraoun, Mohamed El Amine Boudjella, Nabil Debzi, Naima Benidir, Nawel Afredj, Youcef Guerrache, Kamel Bentabak, Philippe Soyer, Salah Eddine Bendib
Budd-Chiari syndrome (BCS) is a rare cause of portal hypertension and liver failure. This condition is characterized by an impaired hepatic venous drainage. The diagnosis of BCS is based on imaging, which helps initiate treatment. Imaging findings can be categorized into direct and indirect signs. Direct signs are the hallmarks of BCS and consist of visualization of obstructive lesions of the hepatic veins or the upper portion of the inferior vena cava. Indirect signs, which are secondary to venous obstruction, correspond to intra- and extrahepatic collateral circulation, perfusion abnormalities, dysmorphy and signs of portal hypertension...
July 2016: Clinical Imaging
Dong Jae Shim, Ji Hoon Shin, Gi-Young Ko, Yook Kim, Kichang Han, Dong-Il Gwon, Heung-Kyu Ko
BACKGROUND: Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. PURPOSE: To report the results of portal vein stent placement with the addition of variceal embolization. MATERIAL AND METHODS: Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study...
June 15, 2016: Acta Radiologica
Masato Shinkai, Kyoko Mochizuki, Norihiko Kitagawa, Hiroshi Take, Hidehito Usui, Kaori Nakamura Yamoto, Shogo Fujita, Youkatsu Ohhama
PURPOSE: Pediatric surgeons currently engage in various abdominal vascular surgeries, which sometimes require vascular conduits or grafts. Herein, we report our experience with patients undergoing vascular reconstruction using a recanalized umbilical vein (rUV) and their long-term outcome. METHOD: Five patients with extrahepatic portal vein obstruction (EHPVO) underwent mesenterico-/porto-left portal vein (PV) bypass surgery using a short rUV conduit with an interposition vein graft...
June 2016: Pediatric Surgery International
Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Yuji Negoro, Akihito Kozuki, Jun Iwata, Yuichi Saisaka, Teppei Tokumaru, Toshio Nakamura, Sojiro Morita
A 61-year-old man was referred to our hospital to treat extrahepatic portal venous obstruction. Endoscopic injection sclerotherapy (EIS) was performed for the esophageal varices; however, the patient returned with massive hematemesis from gastric varices 6 months after treatment. Although the varices were treated with EIS, gastric devascularization and splenectomy concomitant with shunt surgery were required to treat uncontrollable, frequent diarrhea and abdominal distension. Because the splenic vein, left gastric vein, left portal vein, and inferior vena cava were inadequate for anastomosis, an epiploic gonadal vein bypass was performed...
December 2015: Surgical Case Reports
Pramod Kumar Mishra, Nilesh Sadashiv Patil, Sundeep Saluja, Poonam Narang, Nisha Solanki, Vaibhav Varshney
BACKGROUND: Proximal splenorenal shunt (PSRS) is a well-accepted surgical procedure for non-cirrhotic portal hypertension (NCPH). Though a patent shunt is important for good long term outcome, there are very few studies on patency of these shunts. We analysed shunt patency using dynamic computed tomographic (CT) portography and compared it with other modalities. METHODS: From 2004 to 2014, 50 patients with PSRS were evaluated prospectively for shunt patency using dynamic CT portography, clinical parameters and ultrasound Doppler...
March 2016: International Journal of Surgery
Gyan Prakash Rai, Sandeep Nijhawan, M P Madhu, Shyam Sundar Sharma, Rupesh Pokharna
BACKGROUND: Magnetic resonance cholangiopancreatography/magnetic resonance splenoportovenography (MRCP/MRSPV) is now the investigation of choice for the diagnosis of portal cavernoma cholangiopathy (PCC). Endoscopic ultrasound (EUS) is an emerging diagnostic modality for the diagnosis of PCC and may be better than MRCP/MRSPV to see the layer-wise localization of varices and to differentiate between varices, stone, and malignancy. METHODS: Retrospective data of 50 patients of extrahepatic portal vein obstruction (EHPVO) were collected, and comparison between MRCP/MRSPV and EUS was done for the diagnosis of PCC...
November 2015: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Kawtar Al Khalloufi, Adeyinka O Laiyemo
Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, their prevalence has been reported as high as 94% in patients with extrahepatic portal vein obstruction. The diagnosis is typically based on lower endoscopy (colonoscopy or sigmoidoscopy). However, endoscopic ultrasonography has been shown to be superior to endoscopy in diagnosing rectal varices. Color Doppler ultrasonography is a better method because it allows the calculation of the velocity of blood flow in the varices and can be used to predict the bleeding risk in the varices...
December 28, 2015: World Journal of Hepatology
Tae-Yong Ha, Kyung-Mo Kim, Gi-Young Ko, Seak Hee Oh, Tae-Won Kwon, Yong-Pil Cho, Sung-Gyu Lee
BACKGROUND: The aim of this study was to evaluate whether variant meso-Rex bypass with transposition of abdominal autogenous vein can be used as an alternative treatment modality for selected patients with symptomatic extrahepatic portal vein obstruction. METHODS: This was a retrospective review of six consecutive patients who received this alternative procedure for the treatment of symptomatic portal hypertension secondary to idiopathic extrahepatic portal vein obstruction...
2015: BMC Surgery
Frank E Uschner, Ganesh Ranabhat, Steve S Choi, Michaela Granzow, Sabine Klein, Robert Schierwagen, Esther Raskopf, Sebastian Gautsch, Peter F M van der Ven, Dieter O Fürst, Christian P Strassburg, Tilman Sauerbruch, Anna Mae Diehl, Jonel Trebicka
Liver cirrhosis but also portal vein obstruction cause portal hypertension (PHT) and angiogenesis. This study investigated the differences of angiogenesis in cirrhotic and non-cirrhotic PHT with special emphasis on the canonical (Shh/Gli) and non-canonical (Shh/RhoA) hedgehog pathway. Cirrhotic (bile duct ligation/BDL; CCl4 intoxication) and non-cirrhotic (partial portal vein ligation/PPVL) rats received either atorvastatin (15 mg/kg; 7d) or control chow before sacrifice. Invasive hemodynamic measurement and Matrigel implantation assessed angiogenesis in vivo...
2015: Scientific Reports
Seung Duk Lee, Sang-Jae Park, Hyun Boem Kim, Sung-Sik Han, Seong Hoon Kim, Tae Suk You, Young-Kyu Kim, Seong Yeon Cho, Soon-Ae Lee, Young Hwan Ko, Eun Kyung Hong
We present 2 patients showing afferent jejunal varix bleeding around hepaticojejunostomy caused by extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy (PPPD). The case 1 was a 58-year-old woman who had recurrent anemia and hematochezia 3 years after undergoing PPPD. On the portography, the main portal vein was obliterated and collaterals around hepaticojejunostomy were developed. After percutaneous transhepatic balloon dilatation and stent placement through the obliterated portal vein, jejunal varices had disappeared and thereafter no bleeding occurred for 32 months...
February 2012: Korean Journal of Hepato-biliary-pancreatic Surgery
Murali Subbaiah, Sunesh Kumar, Kallol Kumar Roy, Jai Bhagwan Sharma, Neeta Singh
BACKGROUND: Extrahepatic portal-vein obstruction (EHPVO) is a common cause of portal hypertension in developing countries. The main risk in pregnant women with this condition is variceal bleeding, which may be life-threatening. The objective of our study was to assess the outcome of pregnancy in women with EHPVO. MATERIALS AND METHODS: A retrospective analysis of 21 pregnancies in 12 women with EHPVO was carried out at a tertiary hospital in India. RESULTS: The mean age of pregnant women with EHPVO was 25...
August 2015: Taiwanese Journal of Obstetrics & Gynecology
Gloria Chocarro, Paloma Triana Junco, Eva Dominguez, María Virginia Amesty, Vanesa Nuñez Cerezo, Francisco Hernandez, Javier Murcia, Juan Antonio Tovar, Manuel Lopez Santamaria
OBJECTIVE: The mesoportal shunt (MPS) and liver transplantation (LT) have changed the scenario of extrahepatic portal vein obstruction (EHPVO) since the MPS, the only "curative" technique, can now be offered in asymptomatic patients and also thrombotic complications of LT have increased the incidence of EHPVO. MATERIAL AND METHODS: A retrospective study of patients undergoing surgery for EHPVO was conducted between 1990 and 2015. An analysis was done for the shunt permeability and clinical evolution over time...
February 2016: European Journal of Pediatric Surgery
Benjamin L Shneider, Jean de Ville de Goyet, Daniel H Leung, Anshu Srivastava, Simon C Ling, Mathieu Duché, Patrick McKiernan, Riccardo Superina, Robert H Squires, Jaime Bosch, Roberto Groszmann, Shiv K Sarin, Roberto de Franchis, George V Mazariegos
UNLABELLED: Approaches to the management of portal hypertension and variceal hemorrhage in pediatrics remain controversial, in large part because they are not well informed by rigorous clinical studies. Fundamental biological and clinical differences preclude automatic application of approaches used for adults to children. On April 11-12, 2015, experts in the field convened at the first Baveno Pediatric Satellite Meeting to discuss and explore current available evidence regarding indications for MesoRex bypass (MRB) in extrahepatic portal vein obstruction and the role of primary prophylaxis of variceal hemorrhage in children...
April 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Valerio De Stefano, Xingshun Qi, Silvia Betti, Elena Rossi
Splanchnic vein thrombosis (SVT) encompasses Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO), and mesenteric vein thrombosis. Philadelphia-negative myeloproliferative neoplasms (MPNS) are the leading systemic cause of non-cirrhotic and non-malignant SVT and are diagnosed in 40% of BCS patients and one-third of EHPVO patients. In SVT patients the molecular marker JAK2 V617F is detectable up to 87% of those with overt MPN and up to 26% of those without. In the latter, other MPN molecular markers, such as mutations in JAK2 exon 12, CALR and MPL genes, are extremely rare...
January 2016: Thrombosis and Haemostasis
Tadashi Sekimoto, Hitoshi Maruyama, Kazufumi Kobayashi, Soichiro Kiyono, Takayuki Kondo, Taro Shimada, Masanori Takahashi, Osamu Yokosuka
AIM: To evaluate the clinical features and prognoses in adult patients with extrahepatic portal vein obstruction (EHO) from the aspect of portal hypertension during the last 20 years in Japan. METHODS: There were 40 EHO patients (aged 21-77 years; mean ± standard deviation [SD], 54.6 ± 15.0). Clinical findings and prognoses were examined retrospectively during the median observation period of 71.6 months. RESULTS: Twenty-two patients (55%) showed positive signs of portal hypertension; 18 with esophageal varices (F0, one; F1, eight; F2, nine), two with gastric varices (F1, one; F2, one) and seven with mild ascites...
May 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Rika Yoshimatsu, Takuji Yamagami, Masaki Ishikawa, Kenji Kajiwara, Hideaki Kakizawa, Eiso Hiyama, Hirotaka Tashiro, Yoshiaki Murakami, Hiroki Ohge, Kazuo Awai
Four patients underwent embolization therapy for hemorrhage from varices in the jejunal loop after choledochojejunostomy existing in hepatopetal collateral veins due to chronic extrahepatic portal vein obstruction through the afferent veins using microcoils and/or n-butyl cyanoacrylate. In all four patients, all afferent veins were successfully embolized and successful hemostasis was achieved without liver dysfunction. However, recurrence of the varices and rebleeding occurred within a year in two patients...
2016: Minimally Invasive Therapy & Allied Technologies: MITAT
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