Left Portal Vein Thrombosis Complicated by Acute Cholecystitis Cause Liver Atrophy: A Case Report

Background: Portal vein thrombosis (PVT) was infrequently complicated by acute cholecystitis. The clinical signs of PVT are usually non-specific and subclinical. The treatment aim was to re-canalize the portal vein and to avoid serious complications. An early anticoagulation treatment would result in favorable outcome. Case Report: We present a case of acute cholecystitis with sole left portal vein thrombosis causing left liver atrophy in a 59-year-old woman.Conclusions: While the surgeon is familiar with this uncommon condition, the PVT could be detected on the pre-operative images through a tailored CT or MRI. The condition of PVT is often subclinical and might complicate liver atrophy, an early anticoagulation treatment would result in a favorable outcome.

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

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.

Focal Hepatic Hot Spot Sign

The focal hepatic hot spot sign appears as an area of increased radiopharmaceutical uptake of the quadrate lobe of the liver in the arteial an veinous phase. This sign seen on CT is due to obstruction of the superior vena cava and portosystemic venous shunt between the superior vena cava and the left portal vein via the thoracic and internal para-umbilical veins.

Assessment of the patency of the left portal vein during mesoportal shunting in children with extrahepatic portal hypertension

BACKGROUND: One of the most common causes of extrahepatic portal hypertension in children is portal vein thrombosis. The causes of this disease are different and, in most cases, remain unrecognized. Along with this, the mesoportal shunt (Rex shunt) proved itself and today is considered the gold standard to treat extrahepatic portal hypertension in children. The restoration of hepatopetal blood flow eliminates gastroesophageal bleeding, splenomegaly, hypersplenism, and many other complications. For the results of mesoportal shunt to be successful, several conditions must be met, one of which is the patency of the umbilical portion of the left portal vein. Despite the importance of preoperative diagnostics of the patency of this area, the most optimal instrumental research method has not yet been found. AIM: This literature review aims to highlight the main issues of extrahepatic portal hypertension etiopathogenesis, surgical treatment methods, and the most effective preoperative diagnostic methods to assess the patency of the left portal vein. RESULTS: The authors analyzed the sources of domestic and foreign literature on the etiology, pathogenesis of HSV in children, and laboratory and instrumental diagnostic methods to assess the patency of the PVI to plan the mesoportal shunting operation. CONCLUSIONS: Extrahepatic portal hypertension is a polyetiological disease with a possible hereditary predisposition to a thrombotic process under the influence of various triggers. The most common causes of portal vein thrombosis are omphalitis and umbilical vein catheterization in the neonatal period. Unfortunately, to date, none of the existing instrumental diagnostic methods can reliably answer the question about left portal vein patency. Due to the small number of works, the lack of a unified view on the problem of preoperative diagnosis of patients with extrahepatic portal hypertension, we could not reliably determine the specificity, sensitivity, and accuracy of each instrumental method. Therefore, we could not identify the gold standard method. Nevertheless, with further improvement of the methods for preoperative assessment of the left portal vein patency, surgeons will be more likely to predict the successful outcome of mesoportal shunting, which will generally affect the surgical treatment quality of extrahepatic portal hypertension in children.

Ultrasonographic characteristics and outcome of Type III umbilical-portal-systemic venous shunt

Aims: According to a novel in-utero classification termed “umbilical-portal-systemic venous shunt (UPSVS)” recently proposed for an abnormal umbilical, portal and ductal venous system, the portal-systemic shunt belongs to type III UPSVS. This study was designed to examine the ultrasonographic characteristics and outcome of type III UPSVS.Material and methods: All cases of Type III UPSVS diagnosed at our department from April 2016 to December 2020 were retrospectively studied.Results: Seventeen patients with type III UPSVS including 12 type IIIa and 5 IIIb cases were identified. Sonography showed a shunt between the inferior left portal vein and the left hepatic vein in all type IIIa cases. Three cases of type IIIb had a combination of another shunt (2 with type I and one with type IIIa). Integrate intrahepatic portal vein system was not seen in those 2 cases of type IIIb combined with type I UPSVS, leading to termination of pregnancy (TOP). TOP occurred in 4 patients with type IIIa as requested by the parents. Two cases (type IIIa and type IIIb each) underwent surgical procedure for the closure of the shunt. Spontaneous complete closure in 4 type IIIa cases and partial closure in one type IIIb case occurred during a period of 3-16 months.Conclusions: The majority of patients had type IIIa UPSVS presenting a good outcome. The lack of integrate intrahepatic portal vein system was the main reason for TOP in patients with type IIIb UPSVS. These data suggest the UPSVS classification is a useful tool for a prognosis prediction of type III UPSVS.

THE RAMIFICATION PATTERN OF PORTAL VEIN IN LEFT LOBE OF HUMAN LIVER STUDIED BY CORROSION CAST METHOD.

INTRODUCTION: The aim of the study was to know the intrahepatic ramication pattern of portal vein in left lobe of liver & its variations. METHODS: 25 human fresh livers were obtained after autopsy and studied by corrosion cast method. Polymeric granules of butyl butyrate were dissolved in acetone and 20% homogenous solution was made. Solution was injected into portal vein and the injected liver was placed in 10 % formal saline for 24 hours at room temperature (20°C) for polymerization of infused butyl butyrate solution. Maceration of liver tissue achieved by whole-organ immersion in 1.8 N KOH solution at 68°C for 24 hrs. Each cast thus obtained was preserved in glycerin and details were studied. RESULTS: The length of the transverse part of Left portal vein (LPV) varies from 1.5 -3.7 cm (2.6 cm) while the length of umbilical part of LPV varied from 0.5 – 1.5 cm. (1.1cm.) and total length of LPV varies from 2.0 cm.-4.8cm.(3.7cm). Ramication of Left Portal Vein was described on the basis of its umbilical part. Two type of pattern observed Type I (Umbilical Part Turned Inferiorly) 60 % cases & Type II (Umbilical Part Turned Superiorly). For segment II - Cranio- lateral (CAL) branch originated from the convexity of the curved portion of the umbilical part 84 % cases while in 16 % it has originated from the transverse part of the LPV. Segment III- Caudo- lateral branch (CRL) originated from the convexity of the curved portion of the umbilical part of LPV in all the cases. Segment IV- From the concavity, Inferio – medial branch ran downward & medially while superior- medial branch ran superiorly & medially to supply the lower & upper part of segment IV respectively. The both superio- medial & inferio-medial branches were present in 13 of 25 cases (52 %), while only superior -medial branches were present in 16 of 25 cases (64 %) cases & only inferio-medial 21 of 25 cases (84%) in cases. In 5 of 25 cases (20 %), a common trunk has originated from the concavity of curved portion of the umbilical part then it divided in to superior-medial & inferio-medial branches to supply the segment IV. The number of portal branches to the caudate lobe (segment I) varied from 1 to 4 branches: most commonly from LPV (52 %), then portal vein (16%) & then right portal vein12% cases. At least one of these branches was always originated from LPV (100%). The number of the branches to supply the caudate lode was 2 as it observed in 56 %, while 3 braches in 16 % cases & 4 branches were present in only 8% of the cases. The ndings of present CONCLUSIONS: study on hepatic vasculature have immense importance in the eld of hepato-biliary surgeries.