Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms

Contreras, Ramón Gómez; Ferrando, A. Talens; Sprekelsen, Juan Carlos Bernal; Molina, Francisco Javier Landete; Fernández, Carlos García-Gutiérrez

doi:10.17235/reed.2019.6210/2019

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Symptoms caused by type II CEPS typically arise in childhood and early adulthood. Very few cases have been reported in the elderly [ 7 - 10 ]. Here, we present a case of hyperammonemic encephalopathy in a 70-year-old patient who was found to have an extrahepatic porto-azygous shunt stemming from a hypoplastic portal vein (CEPS type II).…”

Section: Introductionmentioning

confidence: 99%

Congenital Porto-Azygous Shunt (Abernethy Malformation Type II) in an Elderly Patient: A Too-Often-Forgotten Occult Abnormality

Tessier¹,

Ido²,

Zanders³

et al. 2022

Cureus

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Congenital extrahepatic portosystemic shunts (CEPS) cause portal blood to circumvent the liver and its metabolism, allowing normally detoxified ammonia to accumulate in the systemic circulation. Hyperammonemia in the elderly often manifests clinically as toxic encephalopathy. We present a case of recurrent altered mental status in a 70-year-old patient that eluded diagnosis over several years. Hyperammonemia was the sole abnormality detected upon a thorough liver function evaluation prompted by the patient’s history of remote liver disease. Enhanced computed tomography revealed an extrahepatic porto-azygous shunt arising from a hypoplastic portal vein. This case illustrates that, albeit rare, CEPS may express themselves for the first time in the elderly, a patient population that is frequently afflicted by many more common causes of altered mental status. CEPS should be considered in the differential diagnosis of inexplicable hyperammonemia in this age group.

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Section: Introductionmentioning

confidence: 99%

Congenital Porto-Azygous Shunt (Abernethy Malformation Type II) in an Elderly Patient: A Too-Often-Forgotten Occult Abnormality

Tessier¹,

Ido²,

Zanders³

et al. 2022

Cureus

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A systematic review and meta-analysis: prevalence and clinical implications of anatomical variants of the hepatic portal vein

Valenzuela-Fuenzalida,

Rodríguez-Osorio,

Salgado-Torres

et al. 2024

Sci Rep

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The hepatic portal vein is the main vascular route responsible for collecting blood from the liver, spleen, pancreas, stomach, gallbladder, and intestines. Its key function is to metabolize the components acquired from the blood. The objective of this study was to analyze the characteristics of HPV variants and understand the possible clinical considerations that arise with them. The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Literature in Health Sciences were researched until January 2024. Tree authors independently performed the search, study selection and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies. Pooled prevalence was estimated using a random effects model. A total of 31 studies met the established selection criteria. In this study, 21 articles were included for the meta-analysis with a total of 51,244 subjects. Of these 21 articles, the topics studied came mainly from Europe and Asia, with three (n = 554; 1.08%) and 11 articles (n = 50,090; 97.75%) respectively, also having six articles from North America (n = 442; 0.86%) and one from Africa (n = 158; 0.31%), discarding the articles from Oceania and South America. For the HPV trifurcation variant, it was 8% (CI = 7-10%). Apropos the right posterior portal vein variant, as the primary tributary from the main HPV, it was 7% (CI = 4-11%). About the right anterior portal vein variant originating from the left portal vein, it was 4% (CI = 1-6%). Finally, the prevalence of the isolated variants was 2% (CI = 1-3%). The knowledge of HPV and its anatomical variants is of utmost importance for both medical professionals and anatomists, as it is one of the vessels that collects blood from many important viscera found in the abdominal cavity, any structural alteration could be crucial in diagnosis and surgical procedures. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-81543-3.

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Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms

Cited by 2 publications

References 10 publications

Congenital Porto-Azygous Shunt (Abernethy Malformation Type II) in an Elderly Patient: A Too-Often-Forgotten Occult Abnormality

Congenital Porto-Azygous Shunt (Abernethy Malformation Type II) in an Elderly Patient: A Too-Often-Forgotten Occult Abnormality

A systematic review and meta-analysis: prevalence and clinical implications of anatomical variants of the hepatic portal vein

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