scholarly journals Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

2018 ◽  
Vol 12 (3) ◽  
pp. 570-577 ◽  
Author(s):  
Jeffrey Sun ◽  
Cheuk-Kwan Sun ◽  
Cheuk-Kay Sun
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Common Hepatic Duct ◽  
Low Grade ◽  
Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

scholarly journals Surgical approach to a left-sided gallbladder

2019 ◽  
Vol 12 (8) ◽  
pp. e230681
Author(s):  
Ryan Pereira ◽  
Marlon Perera ◽  
Matthew Roberts ◽  
John Avramovic
Keyword(s):  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Falciform Ligament ◽  
Biliary Colic ◽  
Common Hepatic Duct ◽  
Critical View Of Safety ◽  
Symptomatic Gallstones ◽  
The Right

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

Surgical Mesoportal Bypass and Portosystemic Shunt Interventions

2019 ◽  
Vol 03 (03) ◽  
pp. 227-239
Author(s):  
Arthie Jeyakumar ◽  
Jeffrey Forris Beecham Chick ◽  
Patrick J. Healey ◽  
Eric J. Monroe
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Splenic Vein ◽  
Clinical Signs ◽  
Endoscopic Management ◽  
Endovascular Techniques ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Shunt Dysfunction ◽  
Clinically Significant

AbstractExtrahepatic portal vein obstruction is defined by obstruction of the extrahepatic portal vein with or without involvement of the intrahepatic veins and does not include isolated thrombosis of the splenic vein or superior mesenteric vein. The etiology may be congenital versus acquired and acute versus chronic. Historically, surgical intervention has been reserved for patients with symptoms refractory to medical or endoscopic management. Over time, however, advances in surgical technique and research have caused a shift in practice. The interventionalists' role is primarily to address clinically significant shunt dysfunction, including shunt stenosis and thrombosis. In this article, the authors discuss the classification and indications of surgical portosystemic conduits, pre-and postoperative imaging, and clinical signs, and endovascular techniques to address shunt dysfunction.

scholarly journals Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Radha Sarawagi ◽  
Shyam Sundar ◽  
Sanjeev K. Gupta ◽  
Sameer Raghuwanshi
Keyword(s):  
Magnetic Resonance ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Anatomical Variations ◽  
Common Hepatic Duct ◽  
Clinical Implications ◽  
Imaging Features ◽  
Type Iv

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented.Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst.Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

Asymptomatic portal vein aneurysms: To treat, or not to treat?

2017 ◽  
Vol 33 (8) ◽  
pp. 513-516 ◽  
Author(s):  
Sameer A Hirji ◽  
Faith C Robertson ◽  
Sergio Casillas ◽  
James T McPhee ◽  
Naren Gupta ◽  
...  
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Thrombus Formation ◽  
Portal Venous System ◽  
Diagnostic Challenge ◽  
Portal Vein Aneurysm ◽  
Routine Surveillance ◽  
Aneurysm Detection ◽  
Small Aneurysms

Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. Conclusion Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts.

scholarly journals Right extended hepatectomy for hilar cholangiocarcinoma: A case report

2020 ◽  
Vol 9 (3) ◽  
pp. 173-176
Author(s):  
Romi Dahal ◽  
Krishna Mohan Adhikari ◽  
Sumita Pradhan ◽  
Ramesh Singh Bhandari
Keyword(s):  
Portal Vein ◽  
Hilar Cholangiocarcinoma ◽  
Hepatic Duct ◽  
Future Liver Remnant ◽  
Operation Time ◽  
Common Hepatic Duct ◽  
Right Hepatectomy ◽  
Liver Remnant ◽  
Extended Right Hepatectomy ◽  
The Right

Radical resection in a case of hilar cholangiocarcinoma is the only curative option. However resection in a hilar cholangiocarcinoma is a challenging procedure because of the low resectability rate. Only a few cases of hilar cholangiocarcinoma are operable because of the advanced nature of disease at presentation. Furthermore, the extent of surgery makes it a complicated process to attempt. We recently had a patient who underwent an open extended right hepatectomy and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma. The tumor was 20 mm in diameter and was located between the right hepatic duct and common hepatic duct. Radiological examination showed that the hepatic artery was not involved but the right portal vein was invaded by the tumor. CT volumetry was done and the future liver remnant was only 20% in the jaundiced patient. Preoperative drainage was done with percutaneous transhepatic biliary drainage from the left side. Portal vein embolization was done to augment future liver remnant to 30%. The patient underwent an extended right hepatectomy (right trisectionectomy combined with caudate lobectomy). The operation time was nearly 300 min, and the intraoperative blood loss was about 500 ml. However, in the postoperative period, the patient developed post hepatic liver failure which was managed successfully with conservative treatment. The postoperative hospital stay was 23 days. The final diagnosis was hilar cholangiocarcinoma with no nodal metastasis (pT2bN0M0) stage II (American Joint Committee on Cancer, AJCC).

Portal vein aneurysm in the liver associated with multiple vascular malformations

1994 ◽  
Vol 29 (6) ◽  
pp. 776-781 ◽  
Author(s):  
Y. Ito ◽  
K. Tarao ◽  
S. Tamai ◽  
S. Ohkawa ◽  
Y. Kuni ◽  
...  
Keyword(s):  
Portal Vein ◽  
Vascular Malformations ◽  
Portal Vein Aneurysm

scholarly journals Mucinous cystic neoplasm of the liver with biliary communication: case report and surgical therapeutic option

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Raphaella Ferreira ◽  
Phillipe Abreu ◽  
Vagner Birk Jeismann ◽  
Vanderlei Segatelli ◽  
Fabricio Ferreira Coelho ◽  
...  
Keyword(s):  
Bile Duct ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Low Grade ◽  
Mucinous Epithelium ◽  
Biliary Communication ◽  
Cystic Liver ◽  
The Right

Abstract Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.

scholarly journals Presence of Cystic Artery in the Calot’s Triangle and Its Relation with Common Hepatic Duct – a Postmortem Study

2013 ◽  
Vol 10 (2) ◽  
pp. 50-56
Author(s):  
Md Khalilur Rahman ◽  
Selina Anwar
Keyword(s):  
Surgical Intervention ◽  
Hepatic Duct ◽  
Biliary Tree ◽  
Cystic Artery ◽  
Common Hepatic Duct ◽  
Common Disease ◽  
Medicine Department ◽  
Medical College ◽  
Iatrogenic Complications ◽  
The Common

Introduction: Most common disease of liver and biliary tree is cholelithiasis which needs surgical intervention. Safe execution of traditional cholecystectomy or laparoscopic surgery needs proper knowledge of the origin, course, branching pattern of the cystic artery and its relation with common hepatic duct. This study was aimed to find the presence of cystic artery in the Calot’s triangle and its relation with common hepatic duct to prevent any iatrogenic complications especially for newer surgeons in this field. Materials and Methods: This study was done on 60 postmortem gallbladder collected from postmortem dead bodies under the guidance of Forensic Medicine department of Rangpur Medical College, Rangpur. After collection of the specimen, the boundary of the Calot’ triangle was identified and course of the cystic artery was observed whether it was passing through the triangle or not. The relation of the cystic artery with the common hepatic duct was also noticed. Results: It was found from the result of the present study that out of 60 cases cystic artery was found as a content of Calot’s triangle in 58 (96.65%) cases. Regarding the relations of the cystic artery, out of 60 specimens, in 54 cases (90%) cystic arteries were observed to pass behind the common hepatic duct. In four cases (6.67%) cystic artery were found crossing over the common hepatic duct and in two cases (3.33%), cystic artery were found crossing below the cystic duct. In one cases, branches of cystic artery (superficial and deep branch) was found. In every specimen a Calot‘s node was found within the Calot‘s triangle. Discussions: The result of the present study was compared with other workers. Though many of the workers found similar results regarding the course of the cystic artery through the Calot’ triangle but some workers found higher number of cystic artery passing outside the triangle. Also higher percentage of cystic artery passing over the common hepatic duct was found by many workers than the present study. DOI: http://dx.doi.org/10.3329/bja.v10i2.17282 Bangladesh Journal of Anatomy, July 2012, Vol. 10 No. 2 pp 50-56

scholarly journals Endoscopic Endoluminal Radiofrequency Ablation and Single-Operator Peroral Cholangioscopy System (SpyGlass) in the Diagnosis and Treatment of Intraductal Papillary Neoplasm of the Bile Duct: A Case Report and Literature Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Tang ◽  
Jian-Guo Qiu ◽  
Xu-Fu Wei ◽  
Heng Xiao ◽  
Xin Deng ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Diagnosis And Treatment ◽  
Low Grade ◽  
Left Hepatic Duct ◽  
Good Physical Condition ◽  
Intraductal Papillary Neoplasm ◽  
Papillary Neoplasm

Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare biliary benign tumor with atypical clinical features and is frequently misdiagnosed. Its treatment is limited and surgical resection is thought to be the only therapeutic option in patients with IPNB. With the aim of increasing the early diagnosis rate of IPNB and providing more therapeutic options for surgeons, we innovatively put forward the concept of combined utilization of SpyGlass and endoscopic endoluminal radiofrequency ablation (ERFA) in the diagnosis and treatment of IPNB.Case Presentation: An 85-year-old woman was referred to our hospital due to right upper quadrant abdominal pain. The image examinations indicated suspicious filling defects at the upper common bile duct. Further evaluation of SpyGlass cholangioscopy showed multiple reddish villous lesions at the left hepatic duct, and SpyBite biopsy under direct visualization demonstrated papillary low-grade dysplasia. In consideration of the advanced age and preference of the patient, the novel ERFA therapy was performed. The procedure was successful without periprocedural complications; the patient recovered uneventfully and was discharged 2 days after the operation. Upon follow-up, the patient was asymptomatic and in good physical condition at 8 months postoperatively.Conclusion: Preliminarily, we demonstrate that the strategy of a combination of SpyGlass and ERAF seems to be a promising, feasible, well-tolerated, and safe management for patients with IPNB. However, more data with larger patient volumes are needed to evaluate its outcomes further.

Diagnosis and surgical treatment of extrahepatic portal vein aneurysm: A case report

Vascular ◽  
2014 ◽  
Vol 23 (5) ◽  
pp. 553-554 ◽  
Author(s):  
Hao He ◽  
Constantine N Antonopoulos ◽  
Konstantinos G Moulakakis ◽  
George S Sfyroeras ◽  
John D Kakisis ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Portal Vein ◽  
Surgical Intervention ◽  
Main Trunk ◽  
Postoperative Course ◽  
Portal Vein Aneurysm

Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-year-old man, who was incidentally diagnosed with an asymptomatic 52 × 65 mm portal vein aneurysm, which was located at the main trunk of the portal vein, just before its bifurcation. The patient was treated with partial clamping of the portal vein aneurysm and aneurysmorrhaphy. Postoperative course was uneventful. Surgical intervention should be considered for patients with large, symptomatic or expanding portal vein aneurysms.

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