The development of extrahepatic portal obstruction after undergoing multiple operations for a congenital dilatation of the bile duct: Report of a case

Furugaki, Koichi; Yoshida, Junichi; Hashizume, Makoto; Ota, Masayuki; Tanaka, Masao

doi:10.1007/s005950050140

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…2,3 In our patient, inflammatory changes due to the leakage of hepaticojejunostomy may have caused EHO because there had been no sign of EHO before her first operation. Intestinal varices with EHO should be treated in relation to perihepatic hemodynamics and associated liver diseases.…”

Section: Discussionmentioning

confidence: 84%

Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology: Report of a Case

et al. 2003

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We report a case of relapsing jejunal varix with extrahepatic portal obstruction, which was successfully treated by embolization using interventional radiology. A 79-year-old woman suffered repeated episodes of tarry stools 2 years after undergoing jejunal resection for a jejunal varix. The bleeding point was inferred to be in the small intestine, and abdominal angiography revealed extrahepatic portal obstruction and the development of a jejunal varix around the hepaticojejunostomy. Because surgical obliteration of the varices or a shunt operation for portal decompression may have been very invasive due to severe adhesions, the jejunal varix was embolized with anhydrous ethanol and interlocking detachable coils. There were no changes in liver enzymes, the clearance rate of indocyanine green, or portal pressure, and there has been no sign of rebleeding for 13 months. Our experience shows that hemostasis can last, as long as the embolization can be done without aggravating portal hypertension. In conclusion, embolization using interventional radiology is a safe and useful method of treating intestinal varices.

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Section: Discussionmentioning

confidence: 84%

Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology: Report of a Case

et al. 2003

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“…The presence of communicating veins is not critical in patients with normal portal flow. Communicating veins may be newly developed vessels caused by postoperative adhesions [1,2]. However, because of their location, we speculate that most of the communicating veins consisted of parabiliary veins [3].…”

Section: Discussionmentioning

confidence: 93%

“…Although periampullary neoplasms are frequent causes of portal vein occlusion, adhesion due to inflammation, trauma, or surgical intervention can cause extrahepatic portal obstruction [1,2]. The parabiliary venous system, which can function as a collateral pathway in cases of portal vein obstruction [3], is surgically interrupted by choledocho-or hepaticojejunostomy (biliary-enteric anastomosis) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Portal flow into the liver through veins at the site of biliary-enteric anastomosis

et al. 2005

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The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.

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“…The etiology of primary EHO remains unclear, but the involvement of abnormal angioplasty, abnormal blood coagulation, and myeloproliferative disorder has been suggested . The causes of secondary EHO are: neonatal omphalitis, tumors, liver cirrhosis, extrahepatic portal thrombus associated with IPH, cholecystitis, cholangitis, pancreatitis, and abdominal surgery …”

Section: Guidelines For Diagnosis Of Aberrant Portal Hemodynamicsmentioning

confidence: 99%

“…The causes of secondary EHO are: neonatal omphalitis, tumors, liver cirrhosis, extrahepatic portal thrombus associated with IPH, cholecystitis, cholangitis, pancreatitis, and abdominal surgery 56,[58][59][60]. EpidemiologyThe number of patients receiving treatment (the number of patients with confirmed disease) in 2004 was estimated at between 340 and 560 (according to the national epidemiological survey in 2005).…”

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confidence: 99%

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Furuichi

Tanaka

Takikawa

et al. 2017

Hepatology Research

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Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.

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The development of extrahepatic portal obstruction after undergoing multiple operations for a congenital dilatation of the bile duct: Report of a case

Cited by 9 publications

References 6 publications

Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology: Report of a Case

Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology: Report of a Case

Portal flow into the liver through veins at the site of biliary-enteric anastomosis

Diagnosis and treatment guidelines for aberrant portal hemodynamics

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