Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Wei, Bo; Huang, Zhiyin; Tang, Cheng-Wei

doi:10.3389/fmed.2022.853138

Cited by 20 publications

(11 citation statements)

References 118 publications

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“…18 patients among the 33 collateral vessels of PV suffered abdominal distension and abdominal pain compared with only 3 with gastrointestinal bleeding. The main symptom of collateral formation caused by other diseases reported is upper gastrointestinal hemorrhage, which is significantly higher than our results [ 7 – 11 ]. All of this may be related to the fact that AE invasion of the vessels is a chronic process, allowing enough time to gradually establish type I collateral vessels, which relieves the venous pressure in the main PV.…”

Section: Discussioncontrasting

confidence: 91%

Collateral circulation caused by end-stage hepatic alveolar echinococcosis

et al. 2023

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Background Hepatic alveolar echinococcosis (HAE), as a benign parasitic disease with malignant infiltrative activity, grows slowly in the liver, allowing sufficient time for collateral vessels to emerge in the process of vascular occlusion. Methods The portal vein (PV), hepatic vein and hepatic artery were observed by enhanced CT and the inferior vena cava (IVC) by angiography, respectively. Analysis of the anatomical characteristics of the collateral vessels helped to look into the pattern and characteristics of vascular collateralization caused by this specific etiology. Results 33, 5, 12 and 1 patients were included in the formation of collateral vessels in PV, hepatic vein, IVC and hepatic artery, respectively. PV collateral vessels were divided into two categories according to different pathways: type I: portal -portal venous pathway (13 cases) and type II: type I incorporates a portal-systemic circulation pathway (20 cases). Hepatic vein (HV) collateral vessels fell into short hepatic veins. The patients with IVC collateral presented with both vertebral and lumbar venous varices. Hepatic artery collateral vessels emanating from the celiac trunk maintains blood supply to the healthy side of the liver. Conclusions Due to its special biological nature, HAE exhibited unique collateral vessels that were rarely seen in other diseases. An in-depth study would be of great help to improve our understanding related to the process of collateral vessel formation due to intrahepatic lesions and its comorbidity, in addition to providing new ideas for the surgical treatment of end-stage HAE.

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Section: Discussioncontrasting

confidence: 91%

Collateral circulation caused by end-stage hepatic alveolar echinococcosis

et al. 2023

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“…It is characterised by the development of collateral vessels over time, allowing blood to bypass the PVT. It has been estimated that CTPV has an incidence of 15.6% among patients who have a portal venous occlusion,8 a condition which in and of itself has an incidence of less than 0.7 per 100 000 per year 9. Our patient’s CT and venogram nicely demonstrate the numerous serpiginous vessels that dilate to bypass the occluded area of the portal vein.…”

Section: Discussionmentioning

confidence: 60%

Closure of a distal splenorenal shunt as a therapy for refractory hyperammonaemia in setting of neuropsychiatric symptoms

Miller,

Bernshteyn,

Achakzai

et al. 2023

BMJ Case Rep

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Before the widespread use of the transjugular intrahepatic portosystemic shunt, portal hypertension was addressed by the creation of an operative distal splenorenal shunt (DSRS). DSRS was largely regarded as a safe and effective therapy, though it did have a risk of precipitating hyperammonaemia and hepatic encephalopathy.A woman suffered a gunshot wound to the abdomen. This trauma led to portal vein thrombosis, cavernous transformation of the vein and eventually bleeding oesophageal varices from portal hypertension. A DSRS was created to decrease portal hypertension. Years later, she had profound depression with psychomotor slowing in the setting of hyperammonaemia. To reduce hepatic encephalopathy as a contributor to her neuropsychiatric condition, her shunt was closed. The hyperammonaemia resolved and neuropsychiatric symptoms improved.This case highlights several interesting clinical features, including portal hypertension due to chronic portal vein occlusion, cavernous transformation, a surgical DSRS causing hyperammonaemia and hepatic encephalopathy manifesting as neuropsychiatric symptoms.

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“…And interventional techniques can benefit patients with CTPV by reducing the need for liver transplantation or increasing opportunities for liver transplantation. [12] 4. Conclusions CTPV is a relatively rare disease and studies associated with IBD are limited.…”

Section: Discussionmentioning

confidence: 99%

A rare complication of people with inflammatory bowel disease after ileostomy: A case report

Jiang,

He,

Wang

2023

Medicine

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Rationale: Venous thromboembolism is one of the common complications of inflammatory bowel disease (IBD), which is a significant health problem worldwide. Factors such as inflammation, medications, and abdominal surgery, contribute to the increased risk of venous thromboembolism in patients with IBD. Cavernous transformation of the portal vein (CTPV) is a relatively rare complications of IBD. Subsequent portal hypertension could be fatal and the clinical treatment is difficult. Thus, early prevention is very crucial. Patient concerns: A 55-year-old man presented to our department with asthenia, hematemesis, and diarrhea. He was diagnosed with Crohn disease for 9 years. Two years ago, He suffered intestinal perforation and received enterectomy and ileostomy. And, anticoagulants were not given during perioperative period and after surgery because of the history of gastrointestinal bleeding. Diagnoses: The patient was given endoscopy inspection showing the varices of esophagus and gastric fundus near cardia. Contrast enhancement CT scan showed portal hypertension, CTPV, gastroesophageal varices, and splenomegaly. Then percutaneous transhepatic portography was performed to make a clear diagnosis. Interventions: Concerned about the risk of surgery, he refused surgical shunting. Conservative treatment was recommended due to technical difficulties instead of interventional therapy. Outcomes: And after a period of fasting, blood transfusion, and parenteral nutrition treatment, the patient did not experience any further vomiting or hematemesis. Lessons: Early identification and treatment of CTPV is difficult. Prevention such as early application of anticoagulant is necessary for patients with IBD undergoing surgery, particularly with simultaneous stoma formation. For IBD patients who are not suitable for anticoagulant therapy, postoperative follow-up monitoring should be more frequent and monitoring time should be extended.

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Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Cited by 20 publications

References 118 publications

Collateral circulation caused by end-stage hepatic alveolar echinococcosis

Collateral circulation caused by end-stage hepatic alveolar echinococcosis

Closure of a distal splenorenal shunt as a therapy for refractory hyperammonaemia in setting of neuropsychiatric symptoms

A rare complication of people with inflammatory bowel disease after ileostomy: A case report

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