Chronic Portal Vein Thrombosis: Transcapsular Hepatic Collateral Vessels and Communicating Ectopic Varices

Abstract Portal vein thrombosis refers to complete or partial obstruction of the portal venous system, in the intrahepatic or extrahepatic venous tract or even in the splenic or superior mesenteric veins. This common and potentially fatal condition can develop in various clinical contexts, especially those of liver cirrhosis, hepatocellular carcinoma, and other solid tumors. Certain characteristics, such as the time since the onset of the thrombus (acute or chronic), its biology (hematic or tumoral), the presence of collateral vessels, and the magnetic resonance imaging aspects, are important components of a thorough, careful analysis, as well as informing decisions regarding the appropriate therapeutic strategy. Here, we present a brief review of the anatomy of the portal venous system and a systematic approach to analyzing the condition, using a mnemonic (ABCD, for age, biology, collaterals, and diffusion). We discuss the various imaging methods and illustrate our discussion with images selected from the case files archived at our facility.

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A73 PHARYNGEAL VARICES AS A COMPLICATION OF PORTAL HYPERTENSION: A CASE SERIES

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.072 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 86-88

Author(s):

J Ghaith ◽

P James ◽

F Wong

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Esophageal Varices ◽

Splenic Vein ◽

Case Series ◽

Brachiocephalic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis ◽

Ectopic Varices ◽

Collateral Vessels

Abstract Background One of the complications of portal hypertension, with or without the presence of cirrhosis, is the development of varices along the length of the gastrointestinal tract. The commonest sites are along the esophagus or in the stomach. Ectopic varices in the small and large bowels can also be observed, but ectopic varices in the pharynx are extremely uncommon. Aims To present a case series and review the literature regarding pharyngeal varcies. Methods - Results Three elderly female patients presented for esophagogastric varices surveillance gastroscopy were diagnosed with pharyngeal varices. One patient has hepatitis C cirrhosis, while the other two non-cirrhotic patients have myeloproliferative neoplasm (MPN). None of the patients had thromboses of the portal vein or its tributaries. All three patient have concomitant esophageal varices, but only one required band ligation of her esophageal varices. All patients are asymptotic except for mild dysphagia. No patient has bled from their pharyngeal varices to date. Two patients have had prophylactic treatment of their portal hypertension with non-selective beta blocker (NSBB), while the third one has not received NSBB prophylaxis because of her age. Conclusions Pharyngeal varices are extremely rare. To date, there are three case reports in the literature, however, we have been able to identify three cases in our practice. The previous two cases reported possible left-sided portal hypertension with splenic vein thrombosis, leading to the development of collateral vessels including a gastrocaval shunt, which by some contiguous route connects to the brachiocephalic vein; and a third case was a complication of neck dissection surgery. In our case series, none of our patients had splenic vein thrombosis. However, none of them has had a careful CT angiogram to delineate the portal vein tributaries and the collateral vessels, which may further help to define their pathogenesis. It is unclear whether NSBB would be effective as primary prophylaxis against their bleeding, The plan is to continue to monitor these patients to learn about the natural history of these pharyngeal varices. Funding Agencies None

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Refractory bleeding from ectopic varices stopped by percutaneous transhepatic portal vein recanalization and stenting

Case Reports in Internal Medicine ◽

10.5430/crim.v3n3p52 ◽

2016 ◽

Vol 3 (3) ◽

pp. 52

Author(s):

Guido Poggi ◽

Cesare Massa Saluzzo ◽

Benedetta Montagna ◽

Chiara Picchi ◽

Francesco Salerno

Keyword(s):

Gastrointestinal Bleeding ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Stent Placement ◽

Severe Bleeding ◽

Jejunal Varices ◽

Vein Thrombosis ◽

Ectopic Varices

Ectopic varices is an uncommon cause of gastrointestinal bleeding. We reported a case of severe bleeding due to jejunal varices which arose as a complication of extrahepatic portal vein thrombosis. The patient was successfully treated by portal vein recanalization and percutaneous transhepatic stent placement.

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Endoscopic Management of Bleeding Ectopic Varices With Histoacryl

HPB Surgery ◽

10.1155/1999/35272 ◽

1999 ◽

Vol 11 (3) ◽

pp. 171-173 ◽

Cited By ~ 19

Author(s):

Deepak K. Bhasin ◽

B. C. Sharma ◽

P. V. J. Sriram ◽

G. Makharia ◽

K. Singh

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Endoscopic Treatment ◽

Endoscopic Management ◽

Endoscopic Injection ◽

Duodenal Varices ◽

Vein Thrombosis ◽

Ectopic Varices

Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.

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Risk Factors Regarding Portal Vein Thrombosis in Chronic Liver Disease

Acta Medica Transilvanica ◽

10.2478/amtsb-2020-0068 ◽

2020 ◽

Vol 25 (4) ◽

pp. 38-41

Author(s):

Liliana Vecerzan ◽

Romeo Gabriel Mihăilă

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Hepatic Cirrhosis ◽

Vascular Diseases ◽

High Rate ◽

Imaging Method ◽

Vein Thrombosis ◽

Common Causes ◽

Portosystemic Collateral ◽

Collateral Vessels

Abstract The portal vein thrombosis (PVT) is one of the most frequent vascular diseases of the liver, with a high rate of morbidity and mortality. The most common causes of the PVT are hepatic cirrhosis, hepatobiliary neoplasms, inflammatory and infectious abdominal diseases, and myeloproliferative syndromes.(1,2) The natural progress of the PVT has as a result portal hypertension which leads to splenomegaly and the formation of portosystemic collateral vessels, as well as gastroesophageal, duodenal and jejunal varices. Ultrasonography, especially Doppler ultrasound, is the most widely used imaging method to asses, supervise and diagnose PVT in patients with hepatopathies. The purpose of acute PVT treatment is to re-permeabilize the obstructed vessels; the endoscopic ligature of the varices in the eventuality of their rupture is safe and extremely efficient in chronic PVT. To conclude, PVT is the most common hepatic vascular disorder, and its prevalence has increased particularly among the patients with chronic hepatopathies.(3)

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Duodeno-Jejunal Varicosities Following Extrahepatic Portal Vein Thrombosis

HPB Surgery ◽

10.1155/1992/16894 ◽

1992 ◽

Vol 5 (2) ◽

pp. 147-153 ◽

Cited By ~ 1

Author(s):

Nick Varsamidakis ◽

Brian R. Davidson ◽

Kenneth Hobbs

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal Pressure ◽

Duodenal Atresia ◽

Left Lobe ◽

Jejunal Loop ◽

Anastomotic Site ◽

Vein Thrombosis ◽

Pass Through ◽

Collateral Vessels

A 31 year old man, under investigation for melena, was found at endoscopy to have varicosities at the site of a duodeno-jejunostomy which had been performed for duodenal atresia when he was three days old. Angiography revealed an occluded portal vein with an extensive collateral circulation. At laparotomy some of the collateral vessels were found to pass through the anastomotic site and directly into the left lobe of the liver. The portal pressure was found to be minimally elevated. Resection of the anastomotic segment was performed with reconstruction using a Roux en Y jejunal loop. Bleeding from collateral vessels passing through an anastomosis site in a patient with extrahepatic portal vein thrombosis has not previously been reported.

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