Hepatic Infarction Caused by Portal Vein Thrombophlebitis Misdiagnosed as Infiltrative Hepatic Malignancy with Neoplastic Thrombus

Abstract Background Hepatic artery thrombosis can lead to graft loss associated with severe hepatic infarction or bile duct ischemia. When anatomical hepatic artery reconstruction is impossible in liver transplantation or hepato-pancreatic biliary surgery, portal vein arterialization (PVA) is proposed as a salvage technique. Herein, we report our experience with a case that showed favorable clinical outcomes after partial PVA during living-donor liver transplantation (LDLT) because of difficulties in arterial reconstruction. Case presentation A 62-year-old woman with non-B, non-C liver cirrhosis complicated with hepatocellular carcinoma was being prepared for LDLT using an extended left lobe graft. The graft presented with two arteries (left hepatic artery, 2 mm; middle hepatic artery, 2 mm). The first anastomosis was performed using the recipient hepatic artery stumps, but no flow was detected on Doppler control because of thrombus formation. The next attempt was executed using the middle colic artery with a radial artery jump graft and the right gastroepiploic artery, but it led to the same result. Thus, the graft oxygen support by the standard arterial procurement was abandoned, and a shunt was created between the ileocecal artery and the vein to obtain PVA. Arteriography of the superior mesenteric artery showed that the shunt was relatively patent, and the portal vein was apparent. No biliary complication or liver abscess occurred postoperatively, and the patient presented with good liver function and no complications related to portal vein hypertension, nor liver fibrosis 18 months after the LDLT. Conclusion Partial PVA with a shunt created between the ileocecal artery and the vein is useful when arterial reconstruction is difficult during LDLT for preventing graft loss caused by severe hepatic infarction or bile duct ischemia.

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An ultrastructural study on the shark liver

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010016011x ◽

1990 ◽

Vol 48 (3) ◽

pp. 512-513

Author(s):

Masako Yamada ◽

Yutaka Tanuma

Keyword(s):

Portal Vein ◽

Kupffer Cells ◽

Ultrastructural Study ◽

Lipid Droplets ◽

Microscopic Level ◽

The Other ◽

Fish Stock ◽

Structural Studies ◽

Light Microscopic Level ◽

Perfusion Fixation

Although many fine structural studies on the vertebrate liver have been reported on mammals, avians, reptiles, amphibians, teleosts and cyclostomes, there are no studies on elasmobranchii liver except one by T. Ito etal. (1962) who studied it on light microscopic level. The purpose of the present study was to as certain the ultrastructural details and cytochemical characteristics of normal elasmobranchii liver and was to compare with the other higher vertebrate ones.Seventeen Scyliorhinus torazame, one kind of elasmobranchii, were obtained from the fish stock of the Ueno Zoo aquarium, Ueno, Tokyo. The sharks weighing about 300-600g were anesthetized with MS-222 (Sigma), and the livers were fixed by perfusion fixation via the portal vein according to the procedure of Y. Saito et al. (1980) for 10 min. Then the liver tissues were immersed in the same fixative for 2 hours and postfixed with 1% OsO4-solution in 0.1 Mc acodylate buffer for one hour. In order to make sure a phagocytic activity of Kupffer cells, latex particles (0.8 μm in diameter, 0.05mg/100 g b.w.) were injected through the portal vein for one min before fixation. For preservation of lipid droplets in the cytoplasm, a series of these procedure were performed under ice cold temperature until the end of dehydration.

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Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the prospective remnant liver volume 705

Gastroenterology ◽

10.1016/s0016-5085(01)80442-x ◽

2001 ◽

Vol 120 (5) ◽

pp. A90-A90

Author(s):

C HILLERT ◽

D BROERING ◽

G KRUPSKI ◽

M GUNDLACH ◽

X ROGIERS

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Liver Volume ◽

Portal Vein Ligation ◽

Remnant Liver ◽

Remnant Liver Volume

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Factors Influencing Pressure in the Portal Vein as Studied in the Intact Animal

Gastroenterology ◽

10.1016/s0016-5085(19)36606-5 ◽

1950 ◽

Vol 16 (1) ◽

pp. 194-210 ◽

Cited By ~ 19

Author(s):

Frederick W. Hoffbauer ◽

Jesse L. Bollman ◽

John L. Grindlay

Keyword(s):

Portal Vein ◽

Intact Animal ◽

Factors Influencing

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The Glissonian Approach of the Hilum

Swiss Surgery ◽

10.1024/1023-9332.5.3.143 ◽

1999 ◽

Vol 5 (3) ◽

pp. 143-146 ◽

Cited By ~ 9

Author(s):

Launois ◽

Maddern ◽

Tay

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Posterior Approach ◽

Hepatic Duct ◽

Rapid Evolution ◽

Hepatic Tissue ◽

Detailed Knowledge ◽

Porta Hepatis ◽

Liver Segment ◽

Glissonian Approach

The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.

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