scholarly journals Surgical intervention for portal hypertension caused by oxaliplatin-based chemotherapy: a case report and a review of literature regarding radiological and/or surgical interventions for oxaliplatin-associated portal hypertension

2020 ◽  
Vol 13 (5) ◽  
pp. 799-805 ◽  
Author(s):  
Daisuke Morioka ◽  
Yusuke Izumisawa ◽  
Kazuya Yamaguchi ◽  
Kei Sato ◽  
Satoshi Komiyama ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Lung Metastases ◽  
Repeat Hepatectomy ◽  
Portal Vein Ligation ◽  
Esophageal Variceal ◽  
Colorectal Cancer Liver Metastases ◽  
Esophageal Variceal Bleeding ◽  
Surgical Interventions ◽  
Portosystemic Shunting

Abstract A 63-year-old man showed massive ascites, massive pleural effusion, severe lower-extremity edema, and repeated esophageal variceal bleeding. Two-year previously, he received 13-courses of oxaliplatin-based chemotherapy (OBC) followed by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for multiple colorectal cancer liver metastases but developed a solitary remaining liver metastasis and multiple lung metastases 2 months after the ALPPS, for which multiple regimens of chemotherapy were conducted. The symptoms were considered attributable to the OBC-associated portal-hypertension. Water-retention symptoms were mitigated by the use of tolvaptan but the variceal bleeding necessitated frequent endoscopic treatments and disallowed restarting antineoplastic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) was considered undesirable because TIPS in this patient might have prohibited future repeat hepatectomy. Thus, the patient underwent splenectomy and surgical portosystemic shunting. Since then, the portal-hypertension symptoms were completely resolved. Thereafter, chemotherapy was able to be recommenced. Moreover, repeat hepatectomy was performed. A literature review demonstrated that radiological and/or surgical interventions for the OBC-associated portal-hypertension have been reported in 31 cases to date. However, this report is the first to show a case of successful treatment of the OBC-associated portal-hypertension with splenectomy and surgical portosystemic shunting, which allowed subsequent chemotherapy followed by repeat hepatectomy.

scholarly journals Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension

2009 ◽  
Vol 21 (2) ◽  
pp. 172-177
Author(s):  
Chih-Lung Chiu ◽  
Yi-Jen Peng ◽  
Wei-Kuo Chang ◽  
Tsai-Yuan Hsieh ◽  
You-Chen Chao ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Initial Presentation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Posttraumatic Intrapancreatic Aortosplenic Fistula Causing Portal Hypertension

2003 ◽  
Vol 11 (3) ◽  
pp. 272-274 ◽  
Author(s):  
Òscar Estrada ◽  
Carlos-A Mestres ◽  
Miguel-A López-Boado ◽  
Juan A Salmerón ◽  
José Visa ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Percutaneous Closure ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Arterioportal fistulas are uncommon. The case of a patient with massive uncontrollable esophageal variceal bleeding is presented. Reversible portal hypertension was caused by a posttraumatic giant intrapancreatic aortosplenic fistula. Percutaneous closure was unsuccessful, and pancreatectomy was performed to control the bleeding. The case is discussed and the literature on this exceptional cause of portal hypertension is reviewed.

scholarly journals Porto-Sinusoidal Vascular Disease as the Cause of Portal Hypertension in Felty’s Syndrome: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Song Yang ◽  
Min Quan ◽  
Yue Li ◽  
Calvin Qian Pan ◽  
Huichun Xing
Keyword(s):  
Rheumatoid Arthritis ◽  
Portal Hypertension ◽  
Literature Review ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Endoscopic Therapy ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Felty's Syndrome ◽  
Felty’S Syndrome

Felty’s syndrome (FS) is a disorder wherein patients with rheumatoid arthritis develop splenomegaly, neutropenia, and in some cases, portal hypertension without underlying cirrhosis. Esophageal variceal bleeding is a complication of FS in patients with portal hypertension. In contrast to splenectomy, few reports exist on the management of variceal bleeding with endoscopic therapy. Moreover, the long-term outcome has not been reported. We present a patient with esophageal variceal bleeding due to portal hypertension secondary to Felty’s syndrome. The patient was followed up for two years postendoscopy intervention. Literature review was performed and the histological features of portal hypertension in FS are discussed. The patient presented with a typical triad of rheumatoid arthritis (RA), splenomegaly, and neutropenia and was diagnosed as Felty’s syndrome in 2012. She was admitted to our hospital in September 2017 for esophageal variceal bleeding. At the time of admission, her liver function test was normal. Abdominal CT showed no signs of cirrhosis and portal vein obstruction. Liver biopsy further excluded diagnosis of cirrhosis and supported the diagnosis of porto-sinusoidal vascular disease (PSVD), which was previously named as noncirrhotic idiopathic portal hypertension (NCIPH). An upper abdominal endoscopy revealed gastric and esophageal varices. A series of endoscopies was performed to ligate the esophageal varices. The patient was followed up for two years and did not show rebleeding. In conclusion, comorbid PSVD might be a cause of portal hypertension in FS patients. The present case had excellent outcome in two years, which supported the use of endoscopic therapy for the management of variceal bleeding in FS patients. Further large prospective study is needed to confirm the findings.

scholarly journals Experience of Vasoactive Therapy from Esophageal Variceal Bleeding in Patients with Hepatic Cyrrosis and Syndrome of Portal Hypertension

2019 ◽  
Vol 3 (2) ◽  
pp. 125-127
Author(s):  
Mikhail M Vinokurov ◽  
Gavril G Sobakin ◽  
Vladimir G Ammosov ◽  
Innokenty K Semenov ◽  
Anton A Yakovlev ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

scholarly journals Long-Term Management of Esophageal Varices by Endoscopic Sclerotherapy (EST): A Review of 12 Years' Experience

1996 ◽  
Vol 2 (4) ◽  
pp. 211-217 ◽  
Author(s):  
Dinesh K. Bhargava ◽  
S. Dasarathy ◽  
Sushma Saksena
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Cirrhosis Of The Liver ◽  
Injection Sclerotherapy ◽  
Endoscopic Sclerotherapy ◽  
Endoscopic Injection ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Term Management

A total of 566 patients with variceal bleeding caused by cirrhosis of the liver, noncirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHO) were treated by repeated endoscopic injection sclerotherapy. This decreased rebleeding was evidenced by a reduction in mean bleeding risk factor and transfusion requirement. Both the factors were significantly (P < 0.001) decreased in all three groups of patients. Rebleeding occurred before eradication in 27.7% of patients with cirrhosis, 24.3% of those with NCPF, and 11% of those with EHO. Significantly more patients with cirrhosis and NCPF bled in comparison to EHO. Irrespective of the etiology, fewer patients of Child's A class bled than those of Child's B and C classes (P < 0.001). The median bleeding-free period was longer in patients with EHO than in those with cirrhosis (P < 0.05). This period was also significantly longer in Child's A class than in Child's B and the latter had a longer median bleeding-free period than Child's C class (P < 0.01). Variceal eradication was achieved in 80% of patients with cirrhosis, 87% of patients with NCPF, and 90% of patients with EHO. The success of variceal eradication was higher in EHO patients in contrast with patients with cirrhosis of the liver. Similarly, eradication was better in Child's A class patients than in Child's B and C class patients. Recurrence of varices and complications were not influenced by the Child's status or etiology of portal hypertension. The probability of survival at 10 years was higher in patients with EHO (88%) and NCPF (80%) than in patients with cirrhosis (50%). Similarly, patients with Child's A (88%) status survived longer than those with Child's B (42%) status, and patients with Child's B status had a longer survival than Child's C status patients (0%). Thus, endoscopic variceal sclerotherapy appears to be a useful procedure for the long-term management of patients after an esophageal variceal bleeding irrespective of the etiology of portal hypertension.

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