Percutaneous transhepatic treatment of a unique portal vein malformation with portal hypertension in a pediatric patient

Background Anomalies of the portal venous system can be congenital or acquired, the latter being related to spontaneous thrombosis or iatrogenic alterations such as complications of perinatal catheterization of the umbilical vein. These conditions can be clinically silent for years and then manifest abruptly causing severe clinical emergencies. Case presentation This case report describes the diagnosis and interventional management of a singular abnormality in the portal venous system of an 8-year-old female that led to severe portal hypertension and acute variceal bleeding. Peculiar imaging findings were not pathognomonic for any of the known congenital and acquired portal vein anomalies: absence of a normal extrahepatic portal vein; splenic and mesenteric veins merging into a dilated left gastric vein; presence of an aberrant mesenteric venous collateral with a stenotic connection with the intrahepatic right portal branch; and absence of porto-systemic shunt. The case was successfully managed with percutaneous transhepatic portography and angioplasty. Conclusions Prompt non-invasive imaging characterization allowed to understand the singular vascular abnormality and mini-invasive interventional radiology management resolved portal hypertension and variceal bleeding.

Complications of pancreatitis: features of the course and tactics of treatment

The aim of this article is to draw attention of gastroenterologists, surgeons and primary care physicians to the features of the course of pancreatitis complications, which tend to have an acute course and are a complex process that causes medical errors and life tragedies. The importance of complications of pancreatitis such as cysts, pseudocysts, fistulas, cholestatic syndrome, portal hypertension syndrome, bleeding from varicose veins of the esophagus, stomach and erosive-ulcerative secondary gastroduodenal processes is emphasized. Attention is focused on the mechanisms of development of these complications, features of the clinical course, management tactics of such patients, depending on the location of the complications, which is important for the treatment strategy (conservative or surgical). The peculiarities of the clinical picture of the syndrome of compression of neighboring organs, thrombosis of the hepatic and splenic veins, biliodigestive bleeding, including hemobilia, bleeding from the large and small duodenal papilla, are directly related to the analytical approach regarding the diagnosis of these complications. Angiographic techniques are considered to be the most effective diagnostic techniques, which include celiacography, upper mesentericography, percutaneous and transhepatic portography. It is indicated that on their basis, techniques for stopping bleeding have been developed, namely endovascular catheter hemostasis.

OCCUPATIONAL RADIATION DOSE PERFORMING HEPATOBILIARY MINIMALLY INVASIVE PROCEDURES IN CHILDREN WEIGHING LESS THAN 20 kg

Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4–20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist’s in PTBD (1.18 μSv); radiographer’s in hepatic veins phlebography with/without stenting (0.25 μSv) and nurse’s in hepatic arteriography/embolization (0.26 μSv). Operators’ E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.

Preoperative Evaluation of Endoscopic Ultrasonography and Portography in Selecting Devascularization Surgery for Esophagogastric Varices

This study assesses the role of endoscopic ultrasonography (EUS) and portography in selection of mode of devascularization surgery for esophagogastric varices (EGV) in patients with portal hypertension and reports our experience in the treatment of EGV with modified devascularization surgery. Forty-two cirrhotic patients with EGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used as the guiding mode for therapy of EGV. In addition to devascularization and splenectomy, esophageal transection (ET) was performed in 26 patients with upward-flow varices (UFV), whereas 16 patients with downward-flow varices (DFV) underwent proximal gastrectomy instead of ET. In both UFV and DFV groups, grade II of intramural varices and extramural collaterals were most commonly observed on EUS imaging. There was no significant difference of EUS grading between these two groups ( P > 0.05). The incidence of postoperative complications, mortality, and recurrent varices were not significantly different between these two groups. The overall 5-year survival rate for UFV group was 69.2 per cent, whereas that for the DFV group was 68.7 per cent ( P > 0.05). Our study shows that devascularization surgery is highly effective for the prevention of recurrent bleeding from EGV, and it provides an alternative treatment modality. Combined PTP and EUS are very helpful in determining adequate modalities of devascularization surgery.