Direction of splenic venous flow assessed by pulsed doppler flowmetry in patients with a large splenorenal shunt. Relatin to spontaneous hepatic encephalopathy.

Ohnishi, Kunihiko; Saito, Masayuki; Sato, Shinichi; Terabayashi, Hidetaka; Nakayama, Toshiko; Takashi, Motohide; Goto, Nobuaki; Iida, Satoshi; Nomura, Fumio; Koen, Hirofumi; Okuda, Kunio

doi:10.2957/kanzo.26.222

Cited by 14 publications

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“…Additional relevant significantly reduced in patients with cirrhosis and large splenorenal shunt as compared with normal subjects and clinical features included uncomplicated portal hypertension without encephalopathy or ascites or gastroesoph-patients with chronic hepatitis [17]. This differs from the observation in our patient in whom duplex Doppler ultraageal varice bleeding (varices were not identified on endoscopy performed during the hospitalization period), sonography showed no stagnation of venous flow in portal and spleen veins and in the varicous splenorenal splenomegaly, and hypersplenism.…”

Section: ) Gastroesophageal Varicescontrasting

confidence: 55%

“…Noninvasive, nonexpensive, harmless, and rapid techniques are ultrasonography [8,[44][45][46], real-transhepatic portography, improved by ultrasonically guided puncture, may be performed with little risk and time/pulsed Doppler ultrasonography (capable of determining the direction and rate of blood flow in large veins) is proved to be superior with regard to delineation of the portal venous system and esophageal varices [56,57]. In [17,47], color Doppler sonography, and duplex Doppler ultrasonography [21,[48][49][50]. Part of the course of the several studies, this procedure was reported to be successful in 96% of the examinations, visualizing collateral veins portocaval anastomotic vessels can be visualized by ultrasonography opposite the left adrenal gland and in the in 81% and varices in 69% of the patients with portal hypertension [56,57].…”

Section: ) Gastroesophageal Varicesmentioning

confidence: 99%

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A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Iannello¹,

Libertini

Martini

et al. 1999

Dig Dis

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The aim of this paper is to describe and discuss, on the basis of a thorough review of the literature, the case of a 70-year-old woman with probable cirrhosis secondary to chronic hepatitis B and C, uncomplicated portal hypertension (without ascites, encephalopathy or bleeding varices), splenomegaly and hypersplenism, and an unusual, spontaneous, large splenorenal shunt and recanalization of the umbilical vein. The tortuous and varicose splenorenal shunt was diagnosed by abdominal ultrasound and CT investigations. A duplex Doppler ultrasonography evaluation was performed to study shunt flow direction and velocity. No gastroesophageal varices were identified on endoscopic examination. The clinical relevance of spontaneous splenorenal shunt, often associated with fundic gastric varices, is discussed.

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Section: ) Gastroesophageal Varicescontrasting

confidence: 55%

Section: ) Gastroesophageal Varicesmentioning

confidence: 99%

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Iannello¹,

Libertini

Martini

et al. 1999

Dig Dis

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“…We believe that ultrasound offers the true estimation of flow direction and that in some cases angiography may give rise to false-positive findings (17,33).…”

Section: Discussionmentioning

confidence: 99%

Morphological and hemodynamic changes in the portal venous system after distal splenorenal shunt: An ultrasound and pulsed doppler study

et al. 1988

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We investigated a group of patients who underwent distal splenorenal shunt using high-resolution real-time equipment and a duplex scanner with the aims: (i) to evaluate the rate of visualization of shunt; (ii) to assess change in size in the portal vein, and (iii) to characterize the flow pattern in the splenic vein and to study flow direction and velocity in the portal vein, thus adding new data on the efficacy of this operation in maintaining hepatic perfusion. Real-time ultrasonography was performed in 29 patients before surgery, after 7 to 30 days and after 4 to 12 months. Direct visualization of the shunt was achieved in 53.5% of the patients. Mean caliber of the portal vein significantly decreased after the operation: preoperative = 1.52 +/- 0.32; after 7 to 30 days = 1.32 +/- 0.16 (p less than 0.001), and after 4 to 12 months = 0.99 +/- 0.19 (p less than 0.001). The overall postoperative incidence of portal thrombosis was 22.2%. Thirteen of these patients also underwent a postoperative (4 to 36 months) pulsed Doppler investigation. Flow towards anastomosis was demonstrated in the splenic vein in 11 patients, and in 7 cases, typical caval pulsatility was observed. Decreased hepatopetal flow in the portal vein was found in 10 of 13 patients. In two patients, no flow was detectable and in the other the flow was hepatofugal. On the basis of our data, we can affirm that pulsed Doppler investigation may provide useful data for the evaluation of shunt patency and preservation of a decreased portal hepatic perfusion in the majority of patients.

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“…Eleven patients had a history of and are frequently associated with a large gastrorenal treatment for esophageal varices by endoscopic injection sclerothershunt. 1 The blood flow of such collaterals is abundant, 2 and apy. All patients were informed of the scientific nature of the investihemorrhage from FV is more serious than that of esophageal gation and gave their informed consent.…”

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Risk factors for hemorrhage from gastric fundal varices

1997

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prospective trials. 8,9 However, the incidence of hemorrhage The incidence and the risk factors of hemorrhage from from FV has not been fully investigated. 3,7 Although several gastric fundal varices (FV) have not been fully evaluauthors have mentioned the incidence of hemorrhage from ated. We therefore conducted a retrospective and pro-FV, 3,7 to our knowledge, there has been no prospective study spective study to define the incidence and risk factors documenting the cumulative risk for FV hemorrhage in a for such episodes. We investigated 132 patients with cirlarge number of patients. The aim of this study was to define rhosis and gastric FV. Of these 132 patients, 15 patients the incidence and the risk factors for hemorrhage from FV. had hemorrhagic FV at the time of enrollment. The clinical characteristics were compared between these pa-PATIENTS AND METHODS tients and those without a first hemorrhage from FV. In Baseline Clinical Assessment. From January 1985 through Decemthe patients who had never previously bled, the inciber 1995, a total of 1,392 cirrhotic patients consecutively underwent dence and risk factors were prospectively investigated.upper gastrointestinal endoscopy at our institute. Of these patients, The size of FV was greater and red-spot on the FV were 540 patients had esophageal varices, 96 patients had gastric varices, more prevalent in patients with hemorrhagic FV. Child's and 253 patients had both esophageal and gastric varices. In the status was also more severe in these patients. In the 117 patients with gastric varices, 143 patients had FV, while the repatients who had never bled, 34 hemorrhages from FV maining 206 patients had varices in the cardia. In the 143 patients occurred during the follow-up period. The cumulative with FV, 11 patients were subsequently excluded from further evaluation because of their refusal to participate in the study. We thus risk for such hemorrhage at 1, 3, and 5 years was 16%, investigated a total of 132 patients with FV in the current study. 36%, and 44%, respectively. A multiple regression analy-The subjects consisted of 89 men and 43 women ranging in age from 1 The blood flow of such collaterals is abundant, 2 and apy. All patients were informed of the scientific nature of the investihemorrhage from FV is more serious than that of esophageal gation and gave their informed consent. The study protocol was apvarices. [3][4][5][6] The treatment of hemorrhagic FV by endoscopic proved by the Hospital Ethics Committee. procedures sometimes fails to cease the bleeding, and surgiAssessment of Endoscopic Findings. The diagnosis of FV was made cal modalities are thus often required for hemostasis.3-6 As a based on endoscopy with the agreement of two experienced endoscoresult, the mortality rate is high in patients with hemor-pists when one or more distinct venous channels were found in the rhagic FV. [3][4][5][6] In addition, because hemorrhagic esophageal gastric fundus. In patients with hemorrhagic FV, the endoscopic findings were analyzed after the cessation o...

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Direction of splenic venous flow assessed by pulsed doppler flowmetry in patients with a large splenorenal shunt. Relatin to spontaneous hepatic encephalopathy.

Cited by 14 publications

References 0 publications

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Morphological and hemodynamic changes in the portal venous system after distal splenorenal shunt: An ultrasound and pulsed doppler study

Risk factors for hemorrhage from gastric fundal varices

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