Re: Left Portal Vein as a Direct Source of Gastric Varices

1999 ◽  
Vol 22 (1) ◽  
pp. 85-86 ◽  
Author(s):  
Jiyong Ahn ◽  
James M. Cooper ◽  
Peter Park ◽  
Harold A. Mitty
Keyword(s):  
Portal Vein ◽  
Gastric Varices ◽  
Left Portal Vein

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

Previous portal hypertension surgery negatively affects results of mesenteric to left portal vein bypass

2008 ◽  
Vol 43 (1) ◽  
pp. 114-119 ◽  
Author(s):  
Anthony C. Chin ◽  
Fiona Thow ◽  
Riccardo A. Superina
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Vein Bypass ◽  
Left Portal Vein

Pyogenic Portal Vein Thrombosis as a Reservoir of Persistent Septicemia after Cyanoacrylate Injection for Bleeding Gastric Varices

Digestion ◽  
2008 ◽  
Vol 78 (2-3) ◽  
pp. 139-143 ◽  
Author(s):  
Chen-Jung Chang ◽  
Yih-Tsong Shiau ◽  
Te-Li Chen ◽  
Ming-Chih Hou ◽  
Chih-Hao Sun ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Gastric Varices ◽  
Vein Thrombosis

scholarly journals A study on branching pattern of main portal vein

2017 ◽  
Vol 06 (02) ◽  
pp. 152-157
Author(s):  
Chaitra BR ◽  
Seema Deepak ◽  
Dakshayani KR
Keyword(s):  
Portal Vein ◽  
Anatomical Variations ◽  
Branching Pattern ◽  
Main Portal Vein ◽  
Human Cadavers ◽  
Portal Vein Anatomy ◽  
Left Portal Vein ◽  
Clear Identification ◽  
Intimate Knowledge ◽  
Transplantation Procedures

Abstract Background: An intimate knowledge and awareness of branching patterns of main portal vein is necessary before hepatic surgeries. The presence of portal vein variants increases the risk of bile duct hilar anatomical variations also. This information may be of help for accurate radiological interpretation, to prevent complications like hemorrhage, difficult anastomosis in the recipient, ischemia in the graft and allograft failure at the time of liver transplantation. Hence the present study was conducted with the objective of observing the branching pattern of the main portal vein, to measure length of right portal vein and angle between right and left portal vein. Material and Methods: The present study was conducted on 84 liver specimens of human cadavers fixed with 5% formalin, collected from the Department of Anatomy and Forensic Medicine, MMC&RI, Mysore. The parameters were measured using image J software. Results: Bifurcation of main portal vein was seen in 75 liver specimens [89.3%]. Trifurcation of main portal vein was seen in 9 specimens [ 10.7%]. Mean angle between Right and left portal vein was 146.7°. Mean length of right portal vein was 2.27 cm. Conclusion: Knowledge of portal vein variations is critically significant in surgical resection and transplantation procedures. Resection of any portion of liver should be well planned and clear identification of sub segments of liver is necessary before surgery. Surgeons and radiologists must have a thorough understanding of variants in portal vein anatomy in order to prevent injury to portal vein and for successful radiological interventions.

The Left Portal Vein: A Possible Source of Confusion on Ultrasonograms

Radiology ◽  
1979 ◽  
Vol 130 (1) ◽  
pp. 205-206 ◽  
Author(s):  
Peter W. Callen ◽  
Roy A. Filly ◽  
William J. DeMartini
Keyword(s):  
Portal Vein ◽  
Left Portal Vein

Computed Tomography with 3d Reconstructions in Planning Two Stage Hepatectomy ALPPS for Alveococcosis of the Liver (Case Report)

2018 ◽  
pp. 81-86 ◽  
Author(s):  
А. Башков ◽  
A. Bashkov ◽  
Ю. Удалов ◽  
Yu. Udalov ◽  
Ж. Шейх ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Abdominal Cavity ◽  
Diagnostic Information ◽  
3D Reconstructions ◽  
Liver Insufficiency ◽  
The Future ◽  
Left Portal Vein

Purpose: To provide case report of alveococcosis of the liver, when ALPPS procedure was planned based on diagnostic information and 3D reconstructions of computed tomography. Material and methods: Computed tomography with bolus intravenous administration of 100 ml of contrast media Ultravist-370 was performed on multislice computed tomography Aquilion 64 Toshiba. Results: The preoperative planning is the crucial part of treatment to minimize or exclude liver insufficiency after resection. The minimal volume of remnant of the liver should be more than 25–30 % for normal parenchyma and more than 40 % in case of chronic pathologic diffuse process in the liver for example steatosis or cirrhosis. If the estimated volume of remnant is not enough to perform resection, two staged hepatectomy should be planned. According to CT data, the parenchyma of segment S2 and most of parenchyma S3, which together constitute the so-called lateral sector of the liver, were preserved. It allowed to plan an extended right-sided resection. However, the volume of the future liver remnant was 410 ml – about 30 % of the functioning part of the liver which was considered insufficient in view of the presence of prolonged biliary hypertension and a decreasing density of the parenchyma. Vascular elements of the left lateral sector – left hepatic artery, left hepatic vein and inferior vena cava were intact, however, there was a possibility of involving the wall of the left portal vein, due to its prolonged contact with the surface of the parasitic lesion. Using the segmentation tool on radiology workstation, a 3D surface model of the liver was built, where the localization of the pathologic lesion and its relationship with the main vessels were visually demonstrated. After preoperative preparation, a decision was made to perform ALPPS procedure. At the first stage intraoperative the adhesion of the parasitic lesion with the left portal vein was confirmed, which required its resection and plastic. Also in addition to the usual volume of the operation, an atypical resection of the S3 segment and Roux-en-Y choledochojejunostomy were performed. On the 7th day after the 1st stage, a control CT scan was performed, at which an increase in the volume of the remnant to 630 ml (46 % of the preserved parenchyma of the liver) was recorded. The hepatic artery, portal and hepatic veins of the future liver remainder were enhanced homogenously; drainage was traced in the area of parenchyma dissection after the second, l stage of the operation, CT was performed in 15 days to exclude liquid accumulations in the abdominal cavity and to assess the condition of the remnant due to a moderate increasing of the level of direct bilirubin up to 98 μmol/l. No pathological changes in the abdominal cavity were revealed, only free pleural effusion was observed in the pleural cavities with partial atelectasis of the lower lobes of the lungs. After conservative therapy the liver insufficiency was resolved. On the 20th day after the operation, the patient was discharged. Conclusion: In the described clinical case, computed tomography with 3D reconstructions made possible to obtain complete diagnostic information that was necessary for the surgeon to assess the resectability of the pathological process and to plan the type of surgical intervention.

ABSENCE OF THE LEFT PORTAL VEIN: A DIFFICULTY FOR REDUCTION OF LIVER GRAFTS?

2000 ◽  
pp. 1731-1732 ◽  
Author(s):  
Andrew Mitchell ◽  
Darius Mirza ◽  
Jean de Ville de Goyet ◽  
John Buckels
Keyword(s):  
Portal Vein ◽  
Left Portal Vein
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