Computed tomographic angiography with three-dimensional reconstruction in patients with complex diverticular disease and portal hypertension

Abstract

We report a case of a patient with portal hypertension secondary to alcoholic cirrhosis (Child's Class C) who initially presented with a colovaginal fistula secondary to acute sigmoid diverticulitis. The patient had a prior history of hepatic cirrhosis with ascites, coagulopathy, and portal hypertension. Computed tomography of the abdomen and pelvis demonstrated a large diverticular phlegmon and ascites. Computed tomographic angiography demonstrated a large left anterior abdominal wall varix in the region of the anticipated sigmoid resection. Three-dimensional reconstruction of the computed tomographic angiography further delineated the path of this large varix, confirming the increased risk from surgical intervention. Following initial conservative treatment with intravenous antibiotics, parenteral nutrition, and percutaneous abscess drainage, a transjugular intrahepatic portosystemic shunt procedure was performed to decompress the portal system varices. A repeat computed tomographic scan with three-dimensional reconstruction confirmed decompression of the varix. A successful sigmoid resection was subsequently performed. Preoperative computed tomographic angiography with three-dimensional reconstruction is a useful adjunct in planning the operative strategy in patients with complex intraabdominal pathology and collateral portovenous flow secondary to portal hypertension.

Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery

“…After conducting a snowball scanning of the references cited in these 22 articles, five additional references were found. Therefore, twenty-seven articles were finally included in the SR [ 14 – 40 ]. Of these, four were comparative studies, of which three were evaluated as appropriate to combine in meta-analyses [ 19 , 37 , 40 ].…”

Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review

“…The overall number of patients prepared for non-hepatic surgery was 64. Table 1 surgery was elective in 62 cases (97%), 16,20,21,[23][24][25][26][27][29][30][31][32][33][34][35][36][37][38] and semi-elective (performed within 72 h of TIPS placement) in 2 cases. 28 Surgery was performed for malignancy in 42 cases (66%) and for benign diseases in 22 cases (34%) including 1 case of TIPS as a preparation for cesarean section (Table 1).…”

“…Ascites was present before TIPS in 33 patients (53%). 16,24,25,28,[30][31][32][33]35,37 Among the 20 patients in whom the ascites status at surgery was reported, ascites had disappeared in 8 (40%), decreased in 6 (30%), and remained unchanged in 6 (30%) cases, respectively.…”