Surgical Shunt Closure via the Lumen of an Intrahepatic Portal Aneurysm

Abstract

Background/Aims: A surgical shunt closure via the lumen of an intrahepatic portal aneurysm was successfully performed in a 70-year-old Japanese woman with hepatic encephalopathy due to hyperammonemia. She had a 4-month history of repeated hepatic encephalopathy which persisted after treatment with oral medicine. Color Doppler ultrasonography and computed tomography revealed a cystic peripheral portal aneurysm, 4 cm in diameter, connecting the posterior branch of the portal vein to the short hepatic vein in the right lobe. Methods: While performing the Pringle maneuver and clamping the inferior vena cava below the liver, the wall of the portal aneurysm was opened, and the site of inflow from the portal vein and the site of outflow to the hepatic vein via the lumen of the portal aneurysm were closed with interrupted sutures. Results: The patient’s postoperative course was uneventful, and she was discharged 12 days after surgery. 12 months after surgery, she had no recurrence of hyperammonemia or hepatic encephalopathy. Conclusion: Surgical shunt closure via the lumen of a portal aneurysm can be performed safely, easily, and completely with good vision.

Feasibility and safety of non-operative management of portal vein aneurysms: a thirty-five year experience

“…This is largely due to the difficulty in obtaining satisfactory anatomical exposure, adequate proximal and distal vascular control, the often friable nature of the portal vein and the highly variable rates of long-term portal vein patency in patients undergoing repair. 6,17,18 Not surprisingly, a recent metanalysis of 96 case reports of PVAs reported a postoperative mortality of 17.5% in patients undergoing surgical repair highlighting the gravity and high cost of an operative intervention for this condition. 6,15,19,20 Observant management has been previously described in some reports, mainly reserved for asymptomatic patients.…”

Successful embolisation of intrahepatic portosystemic venous shunt using AMPLATZER Vascular Plug II

“…Intrahepatic PV shunts can be treated using surgical ligation or with embolisation via the percutaneous transhepatic portal vein approach or transileocolic vein approach under small laparotomy. 9 , 10 PV shunt embolisation using an AVP II from a percutaneous transjugular or transfemoral venous approach has not been reported, but Lee et al 10 previously reported embolisation of a PV shunt using an AVP II via a transhepatic approach. First, they tried to approach the portal side of the PV shunt from the percutaneous transjugular approach, but it was impossible.…”