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Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery (MBS) has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of MBS in patients with compensated advanced chronic liver disease (cALCD) and clinically significant portal hypertension (CSPH). Material and methods: This is an international, multicentric, retrospective study on 63 individuals affected by obesity with cALCD and CSPH who underwent MBS in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was postoperative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, the authors performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (= 9 vs. > 9) score, and type of surgery. Results: One patient (1.6%) experienced gastric leakage and mortality. There were three (5%) reported cases of portal vein thrombosis, two (3%) postoperative acute renal failure, and one (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis (OR: 0.73, 95% CI: 0.55-0.97, P=0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. Conclusion: MBS is safe in patients with cALCD and CSPH performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Pylephlebitis, a septic thrombophlebitis of the portal vein, is an uncommon but serious complication following an abdominal site of infection, most frequently diverticulitis or appendicitis. It has a high mortality rate, yet it commonly presents with unspecific abdominal complaints and fever, making diagnosis by clinical and laboratory examinations alone, impossible. This report highlights the extensive computed tomography (CT) findings of pylephlebitis with multiple hepatic abscesses thought to be secondary to diverticulitis, in a patient presenting with septic shock. Radiological characteristics differentiating the liver lesions from malignancy, and showing the ascending pathway of vascular involvement from the inferior mesenteric vein to portal veins is presented, as well as the search for the primary site of infection. Recognizing and understanding the imaging findings in pylephlebitis is crucial for diagnosis and avoiding delay of appropriate treatment for this otherwise often fatal condition.

Background: Elective splenectomy is the main treatment for a wide range of haematological diseases. Porto-spleno-mesenteric venous thrombosis represents one of the most severe complications of this procedure. The aim of this study was to evaluate risk factors associated with development of portospleno-mesenteric venous thrombosis after elective splenectomy. Methods: All cases of elective splenectomy carried out from April 1st 2017 to January 31st 2023 were included in this single centre retrospective cohort study. Patients' demographics and perioperative data were analysed and correlated with the incidence of postoperative thrombosis. All patients underwent postoperative doppler ultrasound screening for thrombosis. Analysis was performed using SPSS 28, with p-value < 0.05 considered significant. Results: Twenty-two patients (10 women, 12 men) underwent splenectomy during the study period. Indications were: immune thrombocytopenia (n: 6), myeloproliferative disorder (n: 6), hereditary spherocytosis (n: 4), thalassemia (n: 1), lymphoma (n: 1), leukaemia (n: 1), other malignancies (n: 3). Six patients developed porto-spleno-mesenteric venous thrombosis and only 2 of them were symptomatic. Patients were treated with anticoagulation therapy with complete resolution. Analysis identified three main factors associated with thrombosis: spleen diameter (p = 0.03), myeloproliferative disorder (p = 0.02), intraoperative platelet transfusion (p = 0.002) and intraoperative red blood cells transfusion (p = 0.009). Conclusion: Standardized postoperative screening allows prompt diagnosis and treatment of porto-spleno-mesenteric venous thrombosis even in asymptomatic cases. Patient with splenomegaly and affected by myeloproliferative disorder have a greater risk to develop this complication. [ABSTRACT FROM AUTHOR]

Albumin and prealbumin serve as vital markers reflecting hepatic synthesis activity and overall body nutrient status. Hypoproteinemia can result from various etiological factors, with reduced blood inflow into the liver due to portal vein thrombosis being one such cause. However, literature addressing this specific association remains limited. This report presents an atypical case of malnutrition involving a patient who experienced prolonged hypoproteinemia attributable to a gradual decline in hepatic blood perfusion caused by progressive portal thrombosis and cavernous transformation of the portal vein (CTPV). The case encompasses an in-depth analysis of the factors contributing to undernutrition, the etiology and diagnosis of hypoproteinemia, and its clinical implications. Vigilance for the presence of hypoproteinemia is essential in the management of patients afflicted by progressive portal vein thrombosis complicated by CTPV. Timely and effective interventions aimed at rectifying hypoproteinemia can significantly enhance clinical outcomes. Moreover, reduced hepatic blood flow should be considered a plausible underlying cause in cases of unexplained hypoproteinemia, warranting thorough evaluation. This case underscores the importance of recognizing the intricate interplay between hepatic vascular pathology and protein homeostasis in clinical practice.

Objective: Venous thromboembolism is one of the significant complications after elective and emergency splenectomy. Up to 35% of portal and splenic venous thromboembolism has been reported in the first two months after splenectomy for hematologic malignancy. Our objectives were to compare emergency and elective splenectomy and their complications, and to analyze the risks on the development of portal vein thrombosis (PVT). Material and Method: A total of 78 splenectomy cases performed between 2017-2023 and that had complete medical records were included in this study. Of these cases, 39 were emergency and 39 were elective procedures. The two groups were compared retrospectively for risks of PVT. Result: We found a significant relationship between the development of postoperative complications and the risk of PVT (p=0.004). The risk of developing PVT in emergency cases in the post-operative 2 weeks was significantly higher than elective cases (p=0.048). Shorter operation times, larger spleen sizes, lower platelet counts and malignancy in pathology results were found to be significantly in favor of elective cases (p=0.007, p=0.004, p<0.001, p=0.001, respectively). In emergency cases, the need for RBC transfusion and complications were more frequent (p<0.001, p=0.021). Conclusion: High-risk patients should be evaluated for prophylactic anticoagulation with low-molecular-weight heparin in the postoperative period and after discharge. Anticoagulation should be considered for emergency splenectomy, factoring in cost-benefit, and a low suspicion for venous thromboembolism should be maintained with timely investigation. In this sense, our study supports the existing data with its current results. [ABSTRACT FROM AUTHOR]

BackgroundElective splenectomy is the main treatment for a wide range of haematological diseases. Porto-spleno-mesenteric venous thrombosis represents one of the most severe complications of this procedure. The aim of this study was to evaluate risk factors associated with development of porto-spleno-mesenteric venous thrombosis after elective splenectomy.MethodsAll cases of elective splenectomy carried out from April 1st 2017 to January 31st 2023 were included in this single centre retrospective cohort study. Patients’ demographics and perioperative data were analysed and correlated with the incidence of postoperative thrombosis. All patients underwent postoperative doppler ultrasound screening for thrombosis. Analysis was performed using SPSS 28, with p-value < 0.05 considered significant.ResultsTwenty-two patients (10 women, 12 men) underwent splenectomy during the study period. Indications were: immune thrombocytopenia (n: 6), myeloproliferative disorder (n: 6), hereditary spherocytosis (n: 4), thalassemia (n: 1), lymphoma (n: 1), leukaemia (n: 1), other malignancies (n: 3). Six patients developed porto-spleno-mesenteric venous thrombosis and only 2 of them were symptomatic. Patients were treated with anticoagulation therapy with complete resolution. Analysis identified three main factors associated with thrombosis: spleen diameter (p = 0.03), myeloproliferative disorder (p = 0.02), intraoperative platelet transfusion (p = 0.002) and intraoperative red blood cells transfusion (p = 0.009).ConclusionStandardized postoperative screening allows prompt diagnosis and treatment of porto-spleno-mesenteric venous thrombosis even in asymptomatic cases. Patient with splenomegaly and affected by myeloproliferative disorder have a greater risk to develop this complication.

A 74-year-old patient presented with hematochezia and a history of liver cirrhosis with repeated bleeding from esophageal and rectal varices. Endoscopic examination revealed multiple rectal varices with positive red color signs. Ascites, severe portosystemic thrombosis and a splenorenal shunt were diagnosed on a contrast-enhanced dynamic computed tomography examination. From a transjugular approach, we circumvented thrombosed regions by maneuvering double balloon catheters through the shunt and dilated left colic marginal vein. We managed to successfully obliterate the varices.

Abstract Arterioportal fistulas (APFs) are defined as vascular communications between the systemic arteries and portal circulation. APFs are classified as congenital or acquired, large or small, intrahepatic or extrahepatic, and traumatic or spontaneous. The consistent abnormal connection may result in severe presinusoidal portal hypertension, leading to gastrointestinal bleeding (GIB), ascites, elevated liver function enzymes, heart failure, diarrhea, and even pancreatitis or hematobilia in some unusual cases. Indeed, less than half reported cases have GIB, predominately caused by variceal rupture. Peptic ulcer bleeding has rarely been reported in the setting of APFs. Herein, we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding, progressive portal thrombosis, and massive ascites, with these symptoms successfully relieved by endovascular treatment.

Abstract Background Portal vein thrombosis (PVT) is a common complication following splenectomy. It affects between 5 and 55% of patients undergoing surgery with no clearly defined pre-operative risk factors. The aim of this study was to determine the pre-operative risk factors of PVT. Patients and method Single centre, retrospective study of data compiled for every consecutive patient who underwent splenectomy at Toulouse University Hospital between January 2009 and January 2019. Patients with pre- and post-surgical CT scans have been included. Results 149 out of 261 patients were enrolled in the study (59% were males, mean age 52 years). The indications for splenectomy were splenic trauma (30.9%), malignant haemopathy (26.8%) and immune thrombocytopenia (8.0%). Twenty-nine cases of PVT (19.5%) were diagnosed based on a post-operative CT scan performed on post-operative day (POD) 5. Univariate analysis identifies three main risk factors associated with post-operative PVT: estimated splenic weight exceeding 500 g with an OR of 8.72 95% CI (3.3–22.9), splenic vein diameter over 10 mm with an OR of 4.92 95% CI (2.1–11.8) and lymphoma with an OR of 7.39 (2.7–20.1). The role of splenic vein diameter with an OR of 3.03 95% CI (1.1–8.6), and splenic weight with an OR of 5.22 (1.8–15.2), as independent risk factors is confirmed by multivariate analysis. A screening test based on a POD 5 CT scan with one or two of these items present could indicate sensitivity of 86.2% and specificity of 86.7%. Conclusion This study suggests that pre-operative CT scan findings could predict post-operative PVT. A CT scan should be performed on POD 5 if a risk factor has been identified prior to surgery.

Acute cholecystitis stands out as one of the most common surgical pathologies that should always be considered in a right-upper abdominal pain emergency. For this, the importance of a correct diagnosis is well described. However, it has been demonstrated that the simple combination of clinical (pain, Murphy's sign) and laboratory (leukocytosis) parameters alone does not provide for ruling in or ruling out the diagnosis of this condition, unless accompanied by a radiological exam. For a long time, and still today, ultrasonography (US) is by far the first-to-proceed radiologic exam to perform, thanks to its rapidity and very high sensibility and specificity for the diagnosis of simple acute cholecystitis. However, acute cholecystitis can undergo some complications that US struggles to find. In addition to that, studies suggest that multidetector computed tomography (MDCT) is superior in showing complicated forms of cholecystitis in relation to sensibility and specificity and for its capability of reformatting multiplanar (MPR) reconstructions that give a more detailed view of complications. They have shown to be useful for a precise evaluation of vascular complications, the anatomy of the biliary tree, and the extension of inflammation to surrounding structures (i.e., colitis). Therefore, based also on our experience, in patients with atypical presentation, or in cases with high suspicion for a complicated form, a MDCT abdomen scan is performed. In this review, the principal findings are listed and described to create a CT classification of acute complications based on anatomical and topographic criteria. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC), one of the commonest primitive malignant tumors of the liver, is currently considered one of the very high life-threatening tumors. Surgery remains the treatment of choice of HCC and is indicated whenever possible. We present the case of a patient 66 years old , at which abdominal CT scan reveals the presence of HCC in segments 4 and 8, broken, and perisplenic and perihepatic fluid accumulation in the context of declining hemoglobin. Associate there is an incomplete picture of the portal convergence of 1.9 cm, with the lack of visualization of the left portal wreath. Even in the absence of the possibility of curative resection due to spontaneous rupture of the liver tumor, it is made a central necessity hepatectomy and subsegmentectomy 2 and 3 for the other three formations located at this level. Patient's postoperative course was favorable and he was discharged 11 days after surgery. Abdominal MRI performed 2 months postoperatively revealed the presence of multifocal recurrence. Patient dies at 6 months postoperatively.

Introduction: Portal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation as the second therapeutic option after meso-Rex bypass (surgical shunt)., Aim: Analyse the diagnostic profitability of non-invasive scales in order to predict the risk of oesophageal varices (OV) in children with PVT., Material and Methods: Descriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included. There were divided according to the presence of OV and sex, cause, age, previous gastrointestinal bleeding or treatments, results of UGE and scales (Clinical Prediction Rule - CPR), Varices Prediction Rule - VPR), King's Variceal Prediction Score - K-VaPS) and Platelet count/Spleen diameter Ratio - PSR). Qualitative variables were expressed as absolute frequency and percentage, and quantitative variables as median and interquartile range. U Mann-Whitney and Hanley-McNeil tests were used for comparisons., Results: Forty-five UGE were analysed. 80% (n=36) presented OV: median of 3 (2-3) and 33.3% (n=12) required endoscopic variceal ligation. Statistical differences were demonstrated between both groups: CPR (142.39 [132.22-166.53] vs. 122.75 [115.24-133.15]; p=0.003), VPR (9.91 [9.36-11.75] vs. 5.6 [3.34-8.39]; p=0.001), K-VaPS (117.86 [99.66-126.58] vs. 99.64 [94.88-10.18]; p=0.019), PSR (2384.62 [1902.22-3201.63] vs. 1252.5 [579.6-2144.42]; p=0.05), with and area under the curve AUROC>75%, without statistical differences between scales., Conclusions: In paediatric patients with non-cirrotic PVT non-invasive scales can be used as a tool to predict the presence of OV and raise the indication of UGE., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Background: Portal vein thrombosis (PVT) is a common complication following splenectomy. It affects between 5 and 55% of patients undergoing surgery with no clearly defined pre-operative risk factors. The aim of this study was to determine the pre-operative risk factors of PVT.Patients and Method: Single centre, retrospective study of data compiled for every consecutive patient who underwent splenectomy at Toulouse University Hospital between January 2009 and January 2019. Patients with pre- and post-surgical CT scans have been included.Results: 149 out of 261 patients were enrolled in the study (59% were males, mean age 52 years). The indications for splenectomy were splenic trauma (30.9%), malignant haemopathy (26.8%) and immune thrombocytopenia (8.0%). Twenty-nine cases of PVT (19.5%) were diagnosed based on a post-operative CT scan performed on post-operative day (POD) 5. Univariate analysis identifies three main risk factors associated with post-operative PVT: estimated splenic weight exceeding 500 g with an OR of 8.72 95% CI (3.3-22.9), splenic vein diameter over 10 mm with an OR of 4.92 95% CI (2.1-11.8) and lymphoma with an OR of 7.39 (2.7-20.1). The role of splenic vein diameter with an OR of 3.03 95% CI (1.1-8.6), and splenic weight with an OR of 5.22 (1.8-15.2), as independent risk factors is confirmed by multivariate analysis. A screening test based on a POD 5 CT scan with one or two of these items present could indicate sensitivity of 86.2% and specificity of 86.7%.Conclusion: This study suggests that pre-operative CT scan findings could predict post-operative PVT. A CT scan should be performed on POD 5 if a risk factor has been identified prior to surgery. [ABSTRACT FROM AUTHOR]

A 43-year-old-woman admitted to our department because of abdominal pain, abdominal distension, pain on both inner thighs and blurred vision lasting for 3 months. Pancytopenia and positive anti-double stranded DNA (dsDNA) antibodies were noted 5 years prior to her hospitalisation. On admission, the patient was diagnosed with systemic lupus erythematosus (SLE) with retinal vasculitis, panniculitis, cholecystitis and enteritis. The ultrasound test revealed a large amount of ascites, splenomegaly, a hypoechoic band in the liver, and portal hypertension with mildly elevated hepatic venous wedge pressure (15 mmHg). Liver biopsy showed no evidence of hepatitis, cholangitis or liver cirrhosis, leading to the diagnosis of idiopathic non-cirrhotic portal hypertension (INCPH). Prednisolone (PSL) at a daily dose of 50 mg and intravenous cyclophosphamide pulse therapy (IVCY) were initiated for SLE, while diuretics were administered for transudative ascites associated with INCPH. Although these symptoms temporarily improved, 2 months later, SLE and ascites effusion aggravated again, and portal vein thrombosis was confirmed by computed tomography. After increasing the dose of IVCY and adding an anticoagulant agent, all symptoms improved, allowing a reduction of the PSL dose. In the present case, the exacerbation of INCPH was associated with the exacerbation of SLE and the occurrence of portal thrombosis, suggesting an autoimmune and thrombotic mechanism of INCPH. On the other hand, splenomegaly, oesophageal varices, the hypoechoic band remained unchanged, suggesting the established organised INCPH was refractory to immunosuppressive agents. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Posttransplant vascular complications (PTVCs) have a significant effect on graft and patient after living-donor liver transplantation. We aim to determine the incidence of these complications, focusing on the effects of using synthetic venous grafts in vascular reconstruction, versus performing nongraft primary anastomosis. We did not use natural grafts in this study. Settings and design We collected the preoperative/intraoperative and postoperative data prospectively from 39 recipients/donors who underwent living-donor liver transplantation from November 2014 to August 2019 at the department of surgery in Al-Rajehy Liver Hospital, Assiut University. Patients and methods The vascular reconstruction of hepatic veins (HVs) in all patients was performed using synthetic vascular grafts, anastomosing the grafts' HVs (V5 and V8) to the recipients' inferior vena cava, whereas portal veins were reconstructed without grafts. PTVCs were analyzed over 3 months to determine their effect on recipients' morbidity and mortality, and their relation to the use of synthetic grafts in vascular reconstruction. Statistical analysis Data were analyzed via Statistical Package for the Social Science, version 22. We used Student t test or Mann–Whitney test for quantitative data, and χ2 test for qualitative data. Results Among 39 recipients, four (10.26%) died during the follow-up period. Vascular complications were the leading cause of death in three patients. Portal vein thrombosis had the highest incidence rates among the seven recipients having PTVCs, being developed in three (7.69%) of them. It represented the leading cause of death in one patient, whereas HVs thrombosis developed in one (2.56%) recipient, leading to his death on the seventh postoperative day. Conclusion PTVCs have significant effect on graft durability, as well as recipient's morbidity and mortality. The use of synthetic grafting in vascular reconstruction has shown particularly a significant negative effect. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC), one of the commonest primitive malignant tumors of the liver, is currently considered one of the very high life-threatening tumors. Surgery remains the treatment of choice of HCC and is indicated whenever possible. We present the case of a patient 66 years old, at which abdominal CT scan reveals the presence of HCC in segments 4 and 8, broken, and perisplenic and perihepatic fluid accumulation in the context of declining hemoglobin. Associate there is an incomplete picture of the portal convergence of 1.9 cm, with the lack of visualization of the left portal wreath. Even in the absence of the possibility of curative resection due to spontaneous rupture of the liver tumor, it is made a central necessity hepatectomy and subsegmentectomy 2 and 3 for the other three formations located at this level. Patient's postoperative course was favorable and he was discharged 11 days after surgery. Abdominal MRI performed 2 months postoperatively revealed the presence of multifocal recurrence. Patient dies at 6 months postoperatively. [ABSTRACT FROM AUTHOR]

Introduction. Liver diseases with disturbances of hepatic and splanchnic circulation lead to the portal hypertension, with or without a portal vein thrombosis. Objective. This study was based on the testing of hypothesis that more data and more precise diagnosis in patients with disorders of portal circulation can be obtained by using color Doppler ultrasonography (CDU) and computed tomography (CT) with contrast. Methods. The study was conducted from February 2011 to May 2014 and it comprised 120 patients who were suspected to have portal hypertension or already had clinical confirmation of the portal hypertension, patients with hepatitis, and some patients with hematological diseases. The first group of 40 patients was examined by conventional ultrasonography and CDU, the second group by contrast CT, and the third group of patients was examined by both methods (CDU and contrast CT). After six months of adequate therapy, the patients had control examinations with the same diagnostic technique used during their first examination. Results. Retrospective analysis showed that CDU is more sensitive than CT in the assessment of presence and age of thrombi (CDU 93.9%; CT 86.1%). CT gives precise data in detection of portosystemic collaterals. Sensitivity of CT is 100% and its specificity is 67%. Cumulative sensitivity and specificity for most parameters were increased in patients with portal hypertension when both methods were applied. Conclusion. This study emphasizes the possibility of early and more accurate diagnosis achieved when combining two radiological techniques (CDU and contrast CT scan), which is not the case when these methods are used separately.

Abstract: Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12‐month‐old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post‐operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post‐operative ultrasound identified reversed portal flow, finding a non‐anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re‐operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post‐operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation. [ABSTRACT FROM AUTHOR]

Background: Portomesenteric vein thrombosis (PMVT) is considered a rare and potentially fatal complication of bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures in the world. PMVT in LSG was first reported in 2009 by Berthet et al. in a thrombophilic patient. No data exist regarding the real prevalence of this complication specifically after LSG.Methods: We examined retrospectively all the clinical records of patients who underwent LSG for morbid obesity from January 2011 to December 2016. Moreover, we performed a literature search of PubMed, Medscape, and EMBASE databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: 2854 patients underwent LSG for morbid obesity from January 2011 to December 2016. The retrospective analysis of our records revealed only 1 case of PMVT. The 18 studies selected include 62 cases of PMVT after LSG with a prevalence of 0.52% (ranging from 0.2% to 1.81%) and a mortality rate of 1.61%.Conclusions: PMVT is an infrequent but not rare complication in patients who undergo LSG. Short-course antithrombotic prophylaxis (<10 days) could increase the risk of this complication. The authors recommend a postoperative prophylaxis with sodium enoxaparin 40 mg sc once a day for 4 weeks. PMVT mortality in patients who undergo LSG is lower than other causes of portal vein thrombosis (hepatic cirrhosis, tumors, myeloproliferative disorders, etc.) If risk factors for PMVT are present preoperatively, the authors recommend a prophylaxis with sodium enoxaparin 40 mg sc twice daily for 4 weeks. [ABSTRACT FROM AUTHOR]

The discovery of a portal cavernoma following a high digestive hemorrhage in a patient with a history of abortion iterative, is the witness of a chronic evolution of a portal thrombosis and it must impose an etiological investigation of a prothrombotic affection, unrecognized, in this case the antiphospholipid syndrome (Hughes' syndrome). Our observation describes the infra-hepatic obstacle (portal cavernoma), appreciates the extent of the porto-systemic collateral and objectives the multiple hilar and intra-spleen aneurysms, following a chronic and ancient thrombosis of the extra-hepatic portal system. The antiphospholipid syndrome is an acquired immune disorder with thrombogenic potential of polymorphic expression, which should be systematically considered first in any context of portal vein thrombosis, in a young woman with a history of abortions. From a therapeutic point of view, the stage of chronic portal thrombosis during the antiphospholipid syndrome impose prolonged anticoagulation, but this is far from being codified, clashing paradoxically with the potential haemorrhagic risks linked to portal hypertension and the many hyper-rate splenic aneurysms that can rupture. Splenic embolization with obturation and/or exclusion of aneurysms, as well as portal reperfusion surgery are theoretically justified, reserved for highly specialized centers. [ABSTRACT FROM AUTHOR]

Background: Four common causes of mesenteric ischemia identified: arterial embolism, arterial thrombosis, non-occlusive pathologies and mesenteric venous thrombosis (MVT). MVT is an uncommon cause of acute abdominal pain and accounts for 1 in 1000 emergency surgical laparotomies for acute abdomen. Case Presentation: A 31 year old male, previously healthy, with 72 hour history of generalized abdominal pain on examination with signs of peritonitis. He underwent a computed tomographic (CT) scan of the abdomen and pelvis, which demonstrated thrombosis of the portal, splenic and superior mesenteric veins. A laparotomy was performed, we found jejunal necrosis and a bowel resection was required. Hematologic, oncologic and autoimmune studies were performed and all of them were negative. Discussion: Venous thrombosis is almost always secondary to other pathologies. The principle ones are: hypercoagulability and occult neoplasia. The clinical presentation is non-specific. To make a diagnosis one can use: a Doppler ultrasound, a CT angiography, a magnetic resonance and a catheter angiography. The available treatments for acute mesenteric ischemia are: endovascular procedures, bypass surgery, anticoagulation and a laparotomy to treat visceral complications. Conclusion: Even if this is an uncommon pathology, physicians need to be aware of pathophysiology, diagnosis and treatment of acute mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Background: Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). Methods: This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. Results: A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. Conclusions: PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes. [ABSTRACT FROM AUTHOR]

Objective This report discusses the role of both congenital and acquired risk factors in the pathogenesis of portal vein thrombosis (PVT). Study Design We describe the clinical management and treatment of PVT in a preterm newborn with a homozygous mutation of the methylenetetrahydrofolate reductase (MTHFR) and plasminogen activator inhibitor-1 (PAI-1) genes and sepsis by Candida para psilosis. Results Although literature data suggest a minor role of genetic factors in thrombophilia in the case of only one mutation, we hypothesize that combined thrombophilic genetic defects may have a cumulative effect and significantly increase the thrombotic risk. Conclusion It could be appropriate to include more detailed analyses of procoagulant and fibrinolytic factors in the diagnostic workup of neonatal thrombosis, also through the investigation of genetic polymorphisms. The anticoagulant therapy and the removal of concurrent risk factors remain basic steps for the adequate management and prevention of complications. [ABSTRACT FROM AUTHOR]

Portal and mesenteric vein thrombosis is a very uncommon complication of laparoscopic surgery, especially after anti-reflux procedures. We report the case of a twenty-year-old man with a history of alcohol and cocaine consumption. A Nissen fundoplication was performed. The patient received a single 20-mg dose of enoxaparin (Clexane®, Aventis Pharma, Spain) two hours before surgery for antithrombotic prophylaxis. On the seventh postoperative day the patient had a portal and mesenteric venous thrombosis, which was confirmed at laparotomy, with both extensive small-intestine necrosis and partial colon necrosis. Despite anticoagulant therapy, the patient died 24 hours later. Surgical findings were confirmed at necropsy. Portal and mesenteric venous thrombosis is an uncommon but severe and even fatal complication after laparoscopic anti-reflux surgery. When other pro-thrombotic, predisposing conditions such as laparoscopic surgery and cocaine consumption are present, the usual prophylactic doses of low molecular weight heparin might not be sufficient to protect against this life-threatening complication.La trombosis venosa mesentérica y portal es una complicación infrecuente de la cirugía laparoscópica. Presentamos el caso de un varón de 20 años, consumidor de cocaína inhalada, al que se realiza una funduplicatura de Nissen laparoscópica, administrándose 20 mg de enoxaparina (Clexane® , Aventis Pharma, Spain) preoperatoriamente. El séptimo día postoperatorio, el paciente presenta una trombosis venosa mesentérica y portal, que se confirma en la laparotomía, con necrosis de todo el intestino delgado y segmentaria del colon, falleciendo el paciente a las 24 horas, a pesar de la terapia anticoagulante y confirmándose el diagnóstico en la necropsia. La trombosis mesentérica y portal es una complicación infrecuentre, pero grave y potencialmente mortal, de la cirugía laparoscópica del reflujo gastroesofágico. Cuando se asocian varios factores predisponentes con un potencial trombótico demostrado aislado, como la cirugía laparoscópica y el consumo de cocaína, no parece que las dosis habituales de profilaxis tromboembólica sean suficientes para evitar esta grave complicación.

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Background: The treatment of portal thrombosis is very difficult, which can seriously affect the prognosis of the patients, and thus, preventing postoperative portal thrombosis in patients with hepatitis B liver cancer is crucial. Identifying the risk factors in these patients is key to preventing postoperative portal vein thrombosis. However, relevant research is currently lacking. The present study was to study the risk factors for postoperative portal vein thrombosis in patients with hepatitis B liver cancer and its impact on mortality., Methods: We retrospectively included 663 patients with hepatitis B liver cancer admitted to the Second Affiliated Hospital of Anhui Medical University and Shenzhen University General Hospital from January 2017 to December 2021. The patients were divided into a portal thrombosis group (n=54) and a control group (n=609) according to whether they had portal thrombosis after surgery. The clinical characteristics including alcoholism, D-dimer, surgery method and tumor diameter of the two groups were compared, and the treatment and mortality of the patients in the portal thrombosis group were analyzed., Results: The incidence of portal vein thrombosis in patients with hepatitis B liver cancer was 8.14% (54/663). The area under the Receiver operator characteristics curve for the diagnostic value of D-dimer for postoperative portal vein thrombosis in patients with hepatitis B liver cancer was 0.716 (95% CI: 0.650-0.781, P=0.000). Alcoholism, D-dimer >8.74 mg/L, open surgery, and a maximum tumor diameter >5 cm were identified as risk factors for portal vein thrombosis after surgery in patients with hepatitis B hepatitis cancer [odds ratio: 2.991 (95% CI: 1.234-7.249), P=0.015; odds ratio: 3.269 (95% CI: 1.683-6.349), P=0.000; odds ratio: 6.726 (95% CI: 3.419-13.232), P=0.000; odds ratio: 2.443 (95% CI: 1.344-4.442), P=0.003]. Patients with Grade I or II grade Yerdel (96.30%) were cured after treatment, while two patients with III grade (3.70%) died after surgery., Conclusions: The incidence of portal vein thrombosis after surgery in patients with hepatitis B liver cancer is high. Intervention against risk factors may be beneficial to improve the prognosis of patients with hepatitis B liver cancer., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-22-1837/coif). The authors have no conflicts of interest to declare., (2022 Translational Cancer Research. All rights reserved.)

Introduction: Sarcoidosis is a systemic granulomatous disease, characterized by the formation of non-necrotizing granulomas. Even though granulomas are frequently found in liver biopsy, related symptoms rarely occur. In the current article, a case report is pictured to increase the knowledge on portal hypertension in hepatic sarcoidosis., Clinical Situation: A 62-year-old female was diagnosed with variceal bleeding for which elastic banding was performed. The patient was admitted to the intensive care unit (ICU) as the bleeding persisted and she evolved in hemorrhagic shock. Liver ultrasound detected nodular hepatomegaly and partial portal thrombosis. Chest CT showed diffuse hilar adenopathies and interstitial micronodular lesion. Finally, PET-CT detected metabolic active liver, bone marrow, and upper and lower diaphragmatic adenopathies., Clinical Resolution: Multidisciplinary discussion brought major advantages in rapid diagnosis and prompt effective treatment. Cirrhosis was diagnosed by liver nodularity on imaging and liver biopsy. Sarcoidosis diagnosis was supported by the biopsies of liver and lymph node, which yielded non-caseating granulomas infiltration. Chest CT scan and PET-CT were also consistent with this diagnosis. The complementary analysis excluded differential diagnosis. The patient was treated with high-dose methylprednisolone with notable clinical improvements and discharge from the ICU., Conclusion: Hepatic sarcoidosis can present as life-threatening bleeding due to variceal bleeding caused by portal hypertension. Differential diagnosis is broad when hepatic sarcoidosis is suspected. Therefore, a multidisciplinary discussion is warranted. Anatomopathological examination of two potentially involved organs should be considered to make the appropriate diagnosis. Further studies are requested to investigate the pathophysiological mechanism of portal hypertension.

Abstract: Background: Extrahepatic metastases represent a major obstacle for further improving prognosis of hepatocellular carcinoma. Aim: To assess clinical predictors of extrahepatic metastases in a large cohort followed in a single centre. Methods: We evaluated clinical files of 520 consecutive patients with hepatocellular carcinoma admitted from 1994 to 2002 to our Liver Unit. The following risk factors were assessed: age, gender, hepatitis viruses, alcohol, diabetes, size, number and differentiation of hepatocellular carcinoma, percutaneous biopsy, portal thrombosis, alpha-fetoprotein, Child-Pugh, Cancer Liver Italian Program and Model for End-stage Liver Disease scores, Barcelona Clinic Liver Cancer classification, varices, hepatocellular carcinoma treatment. Results: Extrahepatic metastases were detected in 55/520 patients (10.5%) after 0–72 months (median 15, CI 3–20) from initial evaluation. Lower bilirubin, INR, Child-Pugh and Model for End-stage Liver Disease scores, higher alpha-feto protein levels, portal thrombosis and absence of oesophageal varices were all associated with distant metastases at univariate analysis. Absence of oesophageal varices and portal thrombosis resulted as independent predictors (P =0.0003 and P =0.004, respectively) on multivariate logistic regression. Patients with metastases showed poorer survival (3 months) than total hepatocellular carcinoma population (26 months). Conclusions: Extrahepatic metastases of hepatocellular carcinoma are rare but significantly impair prognosis. Extrahepatic metastases were more frequent in patients with well preserved liver function. Absence of oesophageal varices and presence of portal thrombosis were the strongest risk factors. [Copyright &y& Elsevier]

Background: Patients with Myeloproliferative Neoplasms - (MPN) have a high risk of thrombotic complications. Portal vein thrombosis is a severe complication, which in many cases, appears at the onset of the disease; the risk factors are related to the presence of qualitatively altered thrombocytes and leucocytes, leading to their activation and appearance of leukocytes-plateletaggregates; anomalies of portal vein endothelial cells are also implicated. The presence of JAK2V617F mutation increases the risk for splahnic thrombosis. Methods and results: We present three patients with portal vein thrombosis and Budd Chiari syndrome, who were further diagnosed with MPN- the thrombosis was the onset event of the disease. Conclusion: Patients were diagnosed with thrombosis of the portal vein before being diagnosed with MPN. Splenectomy was not associated with risk of thrombosis for the two cases in which it was performed; for one case, splenectomy was a therapeutic method to resolve portal hypertension. All patients had homozygous JAK2 mutation, which is associated in recent studies with increased risk of portal, mesenteric thrombosis. The high number of platelet was difficult to control for all patients. Bone marrow biopsy and determination of JAK status are valuable investigations for patients who have splenoportal thrombosis, with no apparent identifiable cause. [ABSTRACT FROM AUTHOR]

Patent ductus venosus (PDV) is a rare condition, which usually presents secondary to hepatic atrophy and hepatic failure. We have treated eight cases of PDV, all with hypergalactosemia and hyperbilirubinemia. Ultrasonography and three-dimensional computed tomography demonstrated communication between the portal vein and the inferior vena cava. Of the eight PDV cases, three from the older age group (ages 9, 11, and 14 years) had high-density lesions in their brain nucleus, and one case (age 19 years) had undergone prior Kasai portoenterostomy for biliary atresia. Six PDV patients underwent ligation of PDV and the remaining two cases underwent partial banding of PDV with intraoperative monitoring to maintain portal vein pressure (PVP) under 30 cm H(2)O. Improvement of the intrahepatic portal vein flow was achieved by ligation or banding of PDV. Postoperatively, serum galactose and bilirubin fell to normal ranges, but portal thrombus occurred postoperatively in the first case. We subsequently administered postoperative anticoagulation in the remaining cases and experienced no major complications. These results suggest that PDV ligation and banding are effective surgical approaches for patients with PDV. Close postoperative monitoring to avoid portal thrombus is imperative in these cases. [ABSTRACT FROM AUTHOR]

A 60-year-old man with alcoholic liver cirrhosis was admitted to our hospital with severe anemia and tarry stool. Upper gastrointestinal endoscopy revealed grade 4 esophageal varices without bleeding and severe portal hypertensive gastropathy (PHG) of the fornix of the stomach with oozing. These findings suggested that PHG was the cause of progression of anemia. Abdominal computed tomography demonstrated no enhancement of the main portal vein and its first branches, indicating portal thrombosis and cavernous transformation. The patient underwent partial splenic embolization (PSE) to reduce portal hypertension. Two months after PSE was performed, upper gastrointestinal endoscopy showed improvement of PHG and endoscopic variceal ligation was performed to treat the esophageal varices. Contrast-enhanced CT revealed partial enhancement of the main portal vein indicating improvement of portal thrombosis. One year after PSE, hemoglobin had increased from 6.0 to 11.0 g/dl without blood transfusion. Moreover, albumin level had risen from 2.8 to 3.7 g/dl, cholinesterase from 51 to 150 IU/l, and prothrombin time from 47% to 66%. PSE can be an effective alternative for the management of severe PHG with portal vein thrombosis, and it might also be effective in improving liver function. [ABSTRACT FROM AUTHOR]

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Abstract: Introduction. – The cytomegalovirus (CMV) infection is most often asymptomatic. The grave forms concern the immunocompromised patients. We report a new case pf acute CMV hepatitis complicated with portal thrombosis in an immunocompetent patient. Exegesis. – A 29 year old man has presented a CMV hepatitis proved by the presence of pp65 protein and the viral DNA in serum. This infection was complicated by a portal thrombosis and the evolution was rapidly favourable under anticoagulant treatment. Eleven cases of major thrombosis complicating acute CMV infection in immunocompetent patients were previously reported in the English and French literature. The absence of local and general cause, the remission without anticoagulation, the elevated risk of thrombosis in both HIV and CMV seropositive patients, and in CMV seropositive renal transplant patients suggest a causal relation. Various pathogenic hypotheses were raised: presence of antiphospholipid antibodies, absent in our case, procoagulant phenotype induction of infected endothelial cells, proliferation induction of smooth cells. Conclusion. – The acute CMV infection can be considered such as a possible cause of major thrombosis. [Copyright &y& Elsevier]

Copyright of EMC-Radiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Robles R, Fernández JÁ, Hernández Q, Marín C, Ramírez P, Sánchez-Bueno F, Luján JA, Rodríguez JM, Acosta F, Parrilla P. Eversion thromboendovenectomy in organized portal vein thrombosis during liver transplantation. Clin Transplant 2004: 18: 79–84. © Blackwell Munksgaard, 2004 Portal thrombosis is no longer considered a contraindication for transplantation because of the technical experience acquired in the field of liver transplantation and the development of various surgical techniques. All the same, the results obtained in portal thrombosis patients are at times suboptimal, and the surgical technique used (thromboendovenectomy or veno-venous bypass) is also controversial. Between May 1988 and December 2001, 455 liver transplants were performed, of which 32 (7%) presented portal vein thrombosis. Of these, eight belonged to the first 227 transplants (group I), and 24 to the other 228 (group II). Of the 32 cases with portal thrombosis, 20 (62%) were type Ib, seven (22%) type II/III and five (16%) type IV. Twenty-two were males (69%), with a mean age of 50 yr (range: 30–70 yr); the thrombosis in all cases developed over a cirrhotic liver: 15 cases of an ethanolic origin, 11 because of hepatitis C virus, two cases of autoimmune aetiology, one case of primary biliary cirrhosis, one case because of hepatitis B virus and two cases of a cryptogenic origin. Five cases had a history of surgical treatment for portal hypertension. The surgical method in all cases consisted of an eversion thromboendovenectomy (ETEV) under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Once re-canalization was achieved, we performed local heparinization and end-to-end portal anastomosis. In no case was systemic post-operative heparinization performed. In the 32 cases in which thrombectomy was attempted it was achieved in 31 of them (96%), failing only in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis re-thrombosed. The 5-yr survival rate of the patients in the series was 69%, with 10 patients dying, of whom only two from causes related to the thrombosis and the thrombosis treatment, both with type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation is controversial and depends on its extension and the experience of the surgeon. In our experience, ETEV resolves most thromboses (types I, II and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal haemitransposition. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal transit studies have shown contradictory results in patients with portal hypertension. We have studied gastric emptying, small-bowel transit and colonic transit in patients with portal hypertension. The association between small-bowel bacterial overgrowth and gastrointestinal transit was assessed. Methods: Sixteen patients (6 females) with portal hypertension and esophageal varices were included. A newly developed radiological procedure was used to measure gastrointestinal transit during one visit. Variceal pressure was measured and culture of small-bowel aspirate was used to diagnose small-bowel bacterial overgrowth. The results were compared to results obtained in 83 healthy subjects. Results: Half gastric emptying time in male patients was 3.8 (0.9-5.8) h versus 2.5 (0.4-4.0) h in healthy males (median and percentile 10-90; P < 0.05). Small-bowel residence time in male patients was 5.9 (2.0-13.7) h versus 3.2 (1.5-6.0) h in healthy males ( P < 0.05). Small-bowel residence time in patients with bacterial overgrowth was significantly longer than in patients without bacterial overgrowth. Small-bowel residence time was also significantly longer in male patients with alcoholic cirrhosis as compared to male patients with other causes of portal hypertension. Colonic transit in all patients and gastric emptying and small-bowel transit in female patients were not significantly different from healthy subjects. Conclusion: Etiology of liver disease and gender may influence transit in patients with portal hypertension. Small-bowel bacterial overgrowth was associated with delayed small-bowel transit. [ABSTRACT FROM AUTHOR]

A 64-year-old man, who came to us with diarrhea, presented with ectodermal changes such as hyperpigmentation, alopecia, and onychatrophy, and was affected by polyposis in the colorectum and stomach. The polyps were histologically consistent with those in Cronkhite­Canada syndrome (CCS). Interestingly, the patient also had colon cancer, as well as portal thrombosis and a high concentration of antinuclear antibody. Treatment with prednisolone ameliorated the symptoms and the gastrointestinal polyposis, while the cancer was successfully treated with a hemicolectomy. Six months after the surgery, the patient developed nephropathy, with nephrotic-range proteinuria, without recurrence of the cancer. The biopsied renal specimen showed membranous glomerulonephritis. This is a rare case of CCS associated with various complications such as colon cancer, portal vein thrombosis, a high titer of antinuclear antibodies, and membranous glomerulonephritis. Although the pathogenesis of CCS is essentially unknown, these complications might have been indicative of an underlying immunological abnormality. [ABSTRACT FROM AUTHOR]

Portal cavernoma is a network of veins whose caliber, initially millimetric or microscopic, is increased and which contain hepatopedal portal blood. It results from occlusion, thrombotic and always chronic, of the extra-hepatic portal system. Diagnosis is mainly done by imaging. Clinical signs of portal cavernoma are usually related to extra-hepatic portal hypertension (hematemesis due to rupture of oeso-gastric varices, splenomegaly, rectal bleeding from ano-rectal varices, growth retardation in children) and sometimes to the cause of portal hypertension (abdominal pain, venous bowel infarction). Occurrence of portal thrombosis is often the conjunction of a local cause and a prothrombotic disorder which must be systematically detected. Biliary consequences of cavernoma are related to compression of common bile duct and are usually asymptomatic. In case of jaundice or cholangitis, portal decompression by portosystemic shunt can be performed to treat both biliary symptoms and portal hypertension. [Copyright &y& Elsevier]

Acute cholecystitis stands out as one of the most common surgical pathologies that should always be considered in a right-upper abdominal pain emergency. For this, the importance of a correct diagnosis is well described. However, it has been demonstrated that the simple combination of clinical (pain, Murphy's sign) and laboratory (leukocytosis) parameters alone does not provide for ruling in or ruling out the diagnosis of this condition, unless accompanied by a radiological exam. For a long time, and still today, ultrasonography (US) is by far the first-to-proceed radiologic exam to perform, thanks to its rapidity and very high sensibility and specificity for the diagnosis of simple acute cholecystitis. However, acute cholecystitis can undergo some complications that US struggles to find. In addition to that, studies suggest that multidetector computed tomography (MDCT) is superior in showing complicated forms of cholecystitis in relation to sensibility and specificity and for its capability of reformatting multiplanar (MPR) reconstructions that give a more detailed view of complications. They have shown to be useful for a precise evaluation of vascular complications, the anatomy of the biliary tree, and the extension of inflammation to surrounding structures (i.e., colitis). Therefore, based also on our experience, in patients with atypical presentation, or in cases with high suspicion for a complicated form, a MDCT abdomen scan is performed. In this review, the principal findings are listed and described to create a CT classification of acute complications based on anatomical and topographic criteria.

A case of hepatic infarction with portal thrombosis is reported. A 63-year-old woman with liver cirrhosis and esophageal varices was admitted for treatment of the esophagel varices. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) were performed. Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions. Her condition worsened, and she died of hepatic failure. Autopsy revealed splenic and portal vein thrombosis, multiple hepatic infarction, and evidence of chronic pancreatitis. We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis. The hepatic infarction was caused by the portal thrombosis. [ABSTRACT FROM AUTHOR]

ABSTRACT- Morphological changes of the liver were studied in 24 autopsy cases of noncirrhotic portal hypertension of unknown etiology (idiopathic portal hypertension, IPH), and in 123 surgical biopsies from such patients. For comparison, 15 whole-cut liver slices from autopsy cases of noncirrhotic portal fibrosis (NCPF) from India were also studied. Liver pathology was very similar in IPH and NCPF, characterized by phlebosclerotic changes and perivascular fibrosis of the portal vein system, and parenchymal atrophy perhaps secondary to portal circulatory insufficiency. The distribution of lesions was uneven, and despite marked fibrosis and occasional surface nodularity, there was no diffuse pseudonodule formation in the parenchyma. Surgical specimens showed similar changes except for more frequent portal cellular infiltrates, but the changes seen in one biopsy specimen were limited and not always diagnostic. It seems that IPH of Japan and NCPF of India are the same disease, and perhaps hepatoportal sclerosis elsewhere is also the same disease. [ABSTRACT FROM AUTHOR]

Thrombosis of the portal vein (PVT) is generally seen in the setting of liver cirrhosis and to a lesser extent in the absence of cirrhosis. There is no clear guidance in relation to approaching treatment with anticoagulation in this condition. The professional societies and guidelines recommend treatment with traditional anticoagulation like low-molecular-weight heparin and vitamin-K antagonists in patients presenting with acute portal vein thrombosis. There is no clarity in relation to treatment in the setting of chronic PVT and in patients with cirrhosis. Also, the role of direct-acting oral anticoagulants (DOACs) that are becoming a preferred choice for anticoagulation for various other indications is not clear in the case of PVT. There are a very few studies in the medical literature that have investigated the role of DOACs in patients with PVT in different settings. Thus, we performed a systematic review of the literature to study the use of DOACs in PVT in patients with and without cirrhosis. The results of the available studies show that DOACS appears to be a promising choice for the treatment of patients with PVT. The availability of more data in the future along with better availability of the approved reversal agents for various DOACs is expected to make DOACS a preferred choice for the clinicians to treat patients with PVT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Gupta et al.)