136 results on '"Mesenteric Veins abnormalities"'
Search Results
2. Testosterone Replacement Therapy Causing Extensive Portal and Mesenteric Vein Thrombosis.
- Author
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Poirier-Blanchette L, Koolian M, and Schwartz BC
- Subjects
- Craniocerebral Trauma physiopathology, Hormone Replacement Therapy statistics & numerical data, Humans, Hypopituitarism, Male, Mesenteric Veins abnormalities, Middle Aged, Testosterone therapeutic use, Tomography, X-Ray Computed methods, Venous Thrombosis physiopathology, Craniocerebral Trauma complications, Hormone Replacement Therapy methods, Portal Vein abnormalities, Testosterone adverse effects, Venous Thrombosis etiology
- Published
- 2021
- Full Text
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3. Refractory and Severe Hepatogenous Diabetes in a Patient with Cirrhosis Improved by Balloon-Occluded Retrograde Transvenous Obliteration of a Large Portosystemic Shunt.
- Author
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Kasuya S, Hidemasa K, Yamaguchi T, Uchi T, Inaoka T, and Terada H
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- Humans, Iliac Vein abnormalities, Male, Mesenteric Veins abnormalities, Middle Aged, Treatment Outcome, Arteriovenous Fistula complications, Arteriovenous Fistula therapy, Balloon Occlusion methods, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 therapy, Embolization, Therapeutic methods, Liver Cirrhosis complications
- Abstract
A 54-year-old male with liver cirrhosis (Child-Pugh score 5) presented with severe hepatogenous diabetes (HbA1c 12.6%). Contrast-enhanced CT showed a large portosystemic shunt from the inferior mesenteric vein to the left internal iliac vein. Glucose monitoring showed postprandial hyperglycemia and reactive hypoglycemia. After balloon-occluded retrograde transvenous obliteration (BRTO) and partial splenic transarterial embolization, postprandial hyperglycemia was diminished. Seven months later, HbA1c had improved from 12.6% to 6.7%. In this case, postprandial hyperglycemia occurred by direct delivery of glucose into the systemic circulation via the shunt, and fasting hypoglycemia occurred during treatment with oral antidiabetic agents and insufficient gluconeogenesis. BRTO of the portosystemic shunt resulted in improvement in hepatogenous diabetes.
- Published
- 2021
- Full Text
- View/download PDF
4. Embolization of congenital portosystemic shunt presenting after pediatric liver transplantation: Case report and literature review.
- Author
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Rohringer TJ, Ng VL, Amaral JG, and Parra DA
- Subjects
- Abnormalities, Multiple chemically induced, Abnormalities, Multiple diagnostic imaging, Adolescent, Embolization, Therapeutic instrumentation, Female, Gastrointestinal Hemorrhage diagnostic imaging, Gastrointestinal Hemorrhage etiology, Humans, Mesenteric Veins abnormalities, Postoperative Hemorrhage diagnostic imaging, Postoperative Hemorrhage etiology, Tomography, X-Ray Computed, Ultrasonography, Vascular Malformations complications, Vascular Malformations diagnostic imaging, Abnormalities, Multiple therapy, Biliary Atresia surgery, Embolization, Therapeutic methods, Gastrointestinal Hemorrhage therapy, Liver Transplantation, Postoperative Hemorrhage therapy, Vascular Malformations therapy
- Abstract
This case report describes a 13-year 10-month-old girl who underwent a deceased-donor split LT for primary diagnosis of biliary atresia at the age of 12 months, who presented with a lower GI bleed. Ultrasound and CT revealed a venous vascular anomaly involving the cecum and ascending colon, with communication of the SMV and pelvic veins consistent with a CEPS. Associated varices were noted in the pelvis along the uterus and urinary bladder. These findings were confirmed by trans-hepatic porto-venography, which was diagnostic and therapeutic as a successful embolization of the CEPS was performed using micro-coils. There were no complications following the procedure and no further GI bleeding occurred, illustrating the efficacy of this treatment option for CEPS. We discuss the literature regarding the presenting complaint of GI bleeding post-LT, CEPS as a rare cause of GI bleeding and its association with PV, and the classification and treatment of CEPS., (© 2020 Wiley Periodicals LLC.)
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- 2020
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5. Surgical Ligation for the Treatment of an Unusual Presentation of Type II Abernethy Malformation.
- Author
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Zhou M, Zhang J, Luo L, Wang B, Zheng R, Li L, Jing H, and Zhang S
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- Adult, Humans, Ligation, Male, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Mesenteric Veins physiopathology, Portal Vein abnormalities, Portal Vein diagnostic imaging, Portal Vein physiopathology, Treatment Outcome, Vascular Fistula diagnostic imaging, Vascular Fistula physiopathology, Vascular Malformations diagnostic imaging, Vascular Malformations physiopathology, Vena Cava, Inferior abnormalities, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior physiopathology, Mesenteric Veins surgery, Portal Vein surgery, Vascular Fistula surgery, Vascular Malformations surgery, Vena Cava, Inferior surgery
- Abstract
Abernethy malformation is a very rare congenital vascular malformation consisting of diversion of portal blood away from liver, and it is commonly associated with multiple congenital anomalies. Here, we present a case of a male from China with nonspecific abdominal pain associated with an unusual pattern of type II Abernethy malformation, whose was diagnosed with a portosystemic shunt via a giant portal-inferior vena cava fistula (17.22 mm in diameter). The patient underwent a surgical ligation of the portocaval shunt and recovered well. We believe that this is the first case of a type II Abernethy malformation presenting as a portosystemic shunt via the giant portal-inferior vena cava fistula., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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6. An unusual cause of intestinal obstruction: phlebosclerotic colitis.
- Author
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Liu YC and Lee WJ
- Subjects
- Abdominal Pain etiology, Adult, Colitis, Emergency Service, Hospital organization & administration, Female, Humans, Intestinal Obstruction diagnostic imaging, Mesenteric Veins abnormalities, Mesenteric Veins physiopathology, Nausea etiology, Peritoneal Fibrosis surgery, Radiography methods, Tomography, X-Ray Computed methods, Intestinal Obstruction diagnosis, Intestinal Obstruction surgery, Peritoneal Fibrosis complications
- Published
- 2020
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7. Abernethy malformation: Single-center experience from India with review of literature.
- Author
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Sharma S, Bobhate PR, Sable S, Kumar S, Yadav K, Maheshwari S, Amin S, Chauhan A, Varma V, Kapoor S, and Kumaran V
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Diagnosis, Differential, Diagnostic Errors, Familial Primary Pulmonary Hypertension, Female, Humans, India, Liver Transplantation, Male, Portasystemic Shunt, Surgical methods, Retrospective Studies, Tomography, X-Ray Computed, Iliac Vein abnormalities, Mesenteric Veins abnormalities, Portal Vein abnormalities, Vena Cava, Inferior abnormalities
- Abstract
Abernethy malformation is a rare congenital anomaly in which there is direct communication between the portal and systemic venous circulation. The clinical presentation ranges from asymptomatic with incidental detection on imaging to secondary complications of disease or related to associate anomalies. This is a retrospective analysis of data from nine patients with Abernethy malformation at a single center. This is a referral center for Pediatric Cardiology and for Hepatobiliary and Pancreatic Surgery. The patients presented to the Pulmonary Hypertension Clinic/the Hepatobiliary Surgery Clinic. Out of nine patients, four were male. Type II Abernethy malformation was present in five patients whereas three patients had type I malformation. One of the patients had communication between inferior mesenteric vein and internal iliac vein. Five out of nine patients were erroneously diagnosed as idiopathic primary pulmonary hypertension and were treated with vasodilators. One patient required living donor liver transplant. One patient was managed with surgical shunt closure whereas two patients required transcatheter shunt closure. The rest of the patients were managed conservatively. Abernethy malformation is more common than previously thought and the diagnosis is often missed. There are various management options for Abernethy malformation, which includes surgical or transcatheter shunt closure and liver transplant. Management of Abernethy malformation depends upon type, presentation, and size of shunt.
- Published
- 2018
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8. Metastasis of Hepatocellular Carcinoma to Distal Colon Associated With Inferior Mesenteric Arteriovenous Fistula and Tumor Thrombus: a Case Report.
- Author
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Mitsialis V and Lee LS
- Subjects
- Aged, Arteriovenous Fistula diagnostic imaging, Colon, Sigmoid blood supply, Colon, Sigmoid diagnostic imaging, Colon, Sigmoid pathology, Computed Tomography Angiography, Female, Humans, Mesenteric Arteries abnormalities, Mesenteric Arteries diagnostic imaging, Mesenteric Vascular Occlusion diagnostic imaging, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Sigmoid Neoplasms secondary, Sigmoidoscopy, Venous Thrombosis diagnostic imaging, Arteriovenous Fistula etiology, Carcinoma, Hepatocellular pathology, Liver Neoplasms pathology, Mesenteric Vascular Occlusion etiology, Sigmoid Neoplasms complications, Venous Thrombosis etiology
- Published
- 2018
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9. Antiphospholipid syndrome presenting as acute mesenteric venous thrombosis involving a variant inferior mesenteric vein and successful treatment with rivaroxaban.
- Author
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Singh K and Khan G
- Subjects
- Acute Disease, Aged, Antiphospholipid Syndrome diagnostic imaging, Diagnosis, Differential, Factor Xa Inhibitors therapeutic use, Female, Humans, Mesenteric Veins diagnostic imaging, Tomography, X-Ray Computed, Treatment Outcome, Venous Thrombosis diagnostic imaging, Antiphospholipid Syndrome complications, Antiphospholipid Syndrome drug therapy, Mesenteric Veins abnormalities, Rivaroxaban therapeutic use, Venous Thrombosis complications, Venous Thrombosis drug therapy
- Abstract
Acute mesenteric venous thrombosis (MVT) is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein (IMV) is especially uncommon in the setting of antiphospholipid syndrome (APS). Here, we present such a case of seronegative APS initially manifesting as an anomalous IMV thrombosis in a 76-year-old woman. Although guidelines support anticoagulation with vitamin K antagonists in these patients, we anticoagulated with rivaroxaban (a direct oral anticoagulant (DOAC)) due to patient preference, which resulted in complete clinical and endoscopic resolution. IMV thrombosis is a rare form of MVT, only two case reports describe successful anticoagulation with DOACs in the setting of MVT and none report APS as an underlying aetiology. Therefore, this case provides the opportunity to review the pathophysiology of MVT, APS and their medical management including current trends in anticoagulation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
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10. A rare case of portosystemic shunt: Variation of Abernethy malformation.
- Author
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Lee A, Eifer D, and Nguyen ET
- Subjects
- Adult, Female, Humans, Imaging, Three-Dimensional, Mesenteric Veins abnormalities, Portal Vein abnormalities, Predictive Value of Tests, Radiographic Image Interpretation, Computer-Assisted, Splanchnic Circulation, Splenic Vein abnormalities, Vascular Malformations physiopathology, Vascular Malformations therapy, Computed Tomography Angiography, Mesenteric Veins diagnostic imaging, Phlebography methods, Portal Vein diagnostic imaging, Splenic Vein diagnostic imaging, Vascular Malformations diagnostic imaging
- Published
- 2018
- Full Text
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11. Is color Doppler a reliable method for the diagnosis of malrotation?
- Author
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Karaman İ, Karaman A, Çınar HG, Ertürk A, Erdoğan D, and Özgüner İF
- Subjects
- Adolescent, Child, Child, Preschool, Digestive System Abnormalities diagnosis, Female, Humans, Infant, Infant, Newborn, Intestinal Volvulus diagnosis, Intestinal Volvulus diagnostic imaging, Male, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Digestive System Abnormalities diagnostic imaging, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Veins diagnostic imaging, Ultrasonography, Doppler, Color
- Abstract
Purpose: The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study., Methods: UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively., Results: All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%., Conclusion: Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.
- Published
- 2018
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12. Disabling portosystemic encephalopathy in a non-cirrhotic patient: Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein.
- Author
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de Martinis L, Groppelli G, Corti R, Moramarco LP, Quaretti P, De Cata P, Rotondi M, and Chiovato L
- Subjects
- Aged, Balloon Occlusion instrumentation, Catheterization, Central Venous instrumentation, Computed Tomography Angiography, Female, Hepatic Encephalopathy blood, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy therapy, Humans, Hyperammonemia complications, Hyperammonemia etiology, Hypertension, Portal blood, Hypertension, Portal complications, Hypertension, Portal etiology, Iliac Vein abnormalities, Iliac Vein diagnostic imaging, Iliac Vein surgery, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Mesenteric Veins surgery, Phlebography, Ultrasonography, Vena Cava, Inferior abnormalities, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior surgery, Balloon Occlusion methods, Catheterization, Central Venous methods, Hepatic Encephalopathy etiology, Hypertension, Portal surgery
- Abstract
Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments., Competing Interests: Conflict-of-interest statement: All authors have no conflicts of interests to declare.
- Published
- 2017
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13. Minimally invasive treatment of mesenteric arterioportal fistulas in two dogs.
- Author
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Cocca CJ, Weisse C, Berent AC, and Rosen R
- Subjects
- Animals, Arteriovenous Malformations surgery, Computed Tomography Angiography veterinary, Diagnosis, Differential, Dog Diseases diagnostic imaging, Dogs, Embolization, Therapeutic veterinary, Female, Imaging, Three-Dimensional veterinary, Male, Tomography, X-Ray Computed veterinary, Ultrasonography veterinary, Arteriovenous Malformations veterinary, Dog Diseases surgery, Mesenteric Arteries abnormalities, Mesenteric Veins abnormalities
- Abstract
CASE DESCRIPTION Two Pembroke Welsh Corgis with gastrointestinal signs including inappetence, diarrhea, lethargy, and hypersalivation were referred for evaluation. CLINICAL FINDINGS Diagnostic testing included abdominal ultrasonography and CT angiography. One patient had a cranial mesenteric artery-to-mesenteric vein fistula with multiple acquired extrahepatic portosystemic shunts. The second patient had both cranial and caudal mesenteric artery-to-mesenteric vein fistulas and multiple acquired extrahepatic portosystemic shunts. TREATMENT AND OUTCOME Both patients underwent minimally invasive coil embolization of the mesenteric arterioportal fistulas, with complete occlusion confirmed by means of angiography at procedure completion. Clinical outcome approximately 1 year after treatment was assessed as fair to good because of recurrence of clinical signs that required medical management in 1 dog and some persistent serum biochemical abnormalities. CLINICAL RELEVANCE Outcome for the 2 patients described suggested that coil embolization may be a feasible and effective minimally invasive technique for the treatment of mesenteric arterioportal fistulas in dogs. However, further investigation of the potential for chronic hepatic disease in patients with a history of acquired portosystemic shunts is warranted.
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- 2017
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14. Percutaneous treatment of a superior mesenteric artery pseudoaneurysm and arteriovenous fistula with coil embolization: a case report.
- Author
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Kılıç A, Yarlıoğlueş M, Ergün E, Ünal Y, and Murat SN
- Subjects
- Adult, Aneurysm, False etiology, Embolization, Therapeutic instrumentation, Embolization, Therapeutic methods, Humans, Male, Treatment Outcome, Abdominal Injuries complications, Aneurysm, False therapy, Arteriovenous Fistula therapy, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities, Wounds, Penetrating complications
- Abstract
Visceral artery pseudoaneurysm and arteriovenous fistula following penetrating abdominal injuries is a rarely observed complication. Presently described is the case of a 44-year-old male admitted to the hospital after having previously experienced penetrating abdominal trauma. The patient had developed a pseudoaneurysm in the superior mesenteric artery and an arteriovenous fistula between the superior mesenteric artery and vein following surgery. The patient underwent successful coil embolization procedure and he was discharged 1 day after intervention.
- Published
- 2017
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15. A strange case of superior mesenteric venous collar around the superior mesenteric artery.
- Author
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Nayak SB, Mishra S, and George BM
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- Anatomy education, Dissection, Humans, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities
- Abstract
During our dissection classes, we saw a venous collar formed around the superior mesenteric artery (SMA) by the jejunal tributaries of superior mesenteric vein in an adult male cadaver. The jejunal tributaries united themselves to form two common jejunal veins. Upper common jejunal vein crossed superficial to SMA and opened into the SMV in front of the uncinate process of pancreas. The inferior common jejunal vein crossed behind the SMA from left to right and opened into the SMV, 4 cm below this level. A communicating vein connected the two common jejunal veins with each other.
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- 2017
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16. A Nipple Sign on an Ectopic Duodenal Varix.
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Ghazala S, Barrett K, and Karasek V
- Subjects
- Adult, Duodenum diagnostic imaging, Humans, Male, Mesenteric Veins diagnostic imaging, Varicose Veins therapy, Vascular Malformations therapy, Vena Cava, Inferior diagnostic imaging, Duodenum blood supply, Embolization, Therapeutic methods, Mesenteric Veins abnormalities, Varicose Veins diagnosis, Vascular Malformations diagnosis, Vena Cava, Inferior abnormalities
- Published
- 2017
- Full Text
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17. Recurrent Hyperammonemia After Abernethy Malformation Type 2 Closure: a Case Report.
- Author
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Li H, Ma Z, Xie Y, and Tian F
- Subjects
- Computed Tomography Angiography, Female, Hepatic Encephalopathy etiology, Humans, Hyperammonemia diagnosis, Mesenteric Veins diagnostic imaging, Middle Aged, Phlebography methods, Portal Vein diagnostic imaging, Radiography, Interventional, Recurrence, Treatment Outcome, Vascular Malformations complications, Vascular Malformations diagnostic imaging, Embolization, Therapeutic, Hyperammonemia etiology, Mesenteric Veins abnormalities, Portal Vein abnormalities, Vascular Malformations therapy
- Abstract
The Abernethy malformation is a rare congenital malformation defined by the presence of an extrahepatic portosystemic shunt. Although most patients are asymptomatic, clinical encephalopathy is present in 15% of cases. We present a patient with type 2 Abernethy malformation, hyperammonemia, and encephalopathy. Shunt closure was performed successfully using interventional angiography; however, hyperammonemia recurred 3 months later. The diagnosis of Abernethy malformation can be made easily, but the ideal patient management strategy has not yet been established. This is the first reported patient with recurrence of hyperammonemia after interventional treatment; we discuss the therapeutic options for Abernethy malformation.
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- 2017
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18. Hepatoblastoma and Abernethy Malformation Type I: Case Report.
- Author
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Correa C, Luengas JP, Howard SC, and Veintemilla G
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- Angiography, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemoembolization, Therapeutic, Child, Preschool, Cisplatin administration & dosage, Doxorubicin administration & dosage, Fatal Outcome, Hepatectomy methods, Hepatoblastoma diagnostic imaging, Hepatoblastoma drug therapy, Hepatoblastoma surgery, Humans, Liver Failure etiology, Liver Neoplasms diagnostic imaging, Liver Neoplasms drug therapy, Liver Neoplasms surgery, Male, Mesenteric Veins diagnostic imaging, Portal Vein diagnostic imaging, Postoperative Complications etiology, Shock, Hemorrhagic etiology, Tomography, X-Ray Computed, Vascular Malformations diagnostic imaging, Vascular Malformations therapy, Vena Cava, Inferior diagnostic imaging, Hepatoblastoma etiology, Liver Neoplasms etiology, Mesenteric Veins abnormalities, Portal Vein abnormalities, Vascular Malformations complications, Vena Cava, Inferior abnormalities
- Abstract
A 2-year-old boy presented with pneumonia and an abdominal mass was noted incidentally. A right lobe hepatic mass classified as PRETEXT III and congenital absence of the portal vein with drainage of the superior mesenteric vein to the inferior vena cava (Abernethy malformation type I) were confirmed by computed tomography and angiography. After a clinical diagnosis of hepatoblastoma had been made, he was treated with 4 cycles of doxorubicin and cisplatin and hepatic arterial chemoembolization with doxorubicin, after which the tumor was classified as POSTEXT III. He underwent a right extended hepatic lobectomy with resection of the caudate lobe but died on postoperative day 4 due to hepatic failure. The Abernethy malformation type I is associated with the development of hepatic tumors, and the abnormal blood flow might predispose to hepatic failure after liver resection. Extensive study of the hepatic vasculature is warranted in patients with suspected malformations. Liver transplant could be considered in patients with congenital portosystemic shunt and malignant liver tumors.
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- 2017
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19. Color Doppler-An effective tool for diagnosing midgut volvulus with malrotation.
- Author
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Kumar B, Kumar M, Kumar P, Sinha AK, Anand U, and Kumar A
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- Child, Preschool, Digestive System Abnormalities surgery, Female, Humans, Infant, Intestinal Volvulus surgery, Male, Mesenteric Artery, Superior abnormalities, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Predictive Value of Tests, Digestive System Abnormalities diagnostic imaging, Intestinal Volvulus diagnostic imaging, Ultrasonography, Doppler, Color
- Abstract
Background: Malrotation with midgut volvulus is a common surgical emergency in children. A diagnostic tool for malrotation with characteristics ideal in emergency settings such as non-invasiveness and rapidity remains a keenly debated issue among surgeons and radiologists alike., Methods: Fifty-two pediatric patients of suspected malrotation with midgut volvulus were studied between 1998 and 2016. All patients underwent plain abdominal X-ray and Color Doppler; contrast upper gastrointestinal (GI) studywas done in some patients. All cases were operated and diagnosis was confirmed. A subset of 60 pediatric patients with nonspecific GI complaints were also examined to see relative position of superior mesenteric vein (SMV)/superior mesenteric artery (SMA) in control population., Result: A total of 52 suspected cases of malrotation were admitted from May 1998 to November 2015, 43 had inversion of SMA/SMV and nine had SMV anterior of SMA in Color Doppler. All 43 cases of inversion of SMA/SMV were cases of malrotation after surgical confirmation; while five out of nine cases of SMV anterior to SMA had malrotation., Conclusion: In appropriate clinical settings, Color Doppler documenting the reversal or aberrant SMV/SMA axis is not only predictive but also diagnostic of malrotation of gut.
- Published
- 2017
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20. Intestinal malrotation in patients with situs anomaly: Implication of the relative positions of the superior mesenteric artery and vein.
- Author
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Choi KS, Choi YH, Cheon JE, Kim WS, and Kim IO
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- Adult, Aged, Digestive System Abnormalities pathology, Female, Humans, Intestinal Volvulus pathology, Male, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities, Middle Aged, Prospective Studies, Reproducibility of Results, Rotation, Situs Inversus pathology, Digestive System Abnormalities diagnostic imaging, Intestinal Volvulus diagnostic imaging, Magnetic Resonance Imaging, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Veins diagnostic imaging, Radiography, Situs Inversus diagnostic imaging, Ultrasonography
- Abstract
Purpose: To assess the usefulness of the relative position of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in diagnosing intestinal malrotation in situs anomaly., Materials and Methods: From January 2004 to April 2015, 33 patients with situs anomalies were enrolled in this study who underwent abdominal USG, CT or MRI as well as upper gastrointestinal series (UGIS) or surgery: situs inversus (n=16), left isomerism (n=10), and right isomerism (n=7); age 21.2±23.2years (mean±standard deviation), range 0-72 years. The intestinal malrotation was confirmed with UGIS and/or operation in 16 patients. Relative positions of the SMV to the SMA were classified into four groups by reviewing abdominal USG, CT, or MRI: right sided, left sided, ventral sided, and dorsal sided. The incidence of malrotation was analyzed for each group., Results: In 16 patients with situs inversus, there was reversed SMA-SMV relationship: left sided (n=11) or ventral sided (n=5). One situs inversus patient with ventral sided SMV had intestinal malrotation (6.25%). 17 patients with situs ambiguus showed various SMA-SMV relationships (ventral sided, n=7; left sided, n=5; right sided, n=4; dorsal sided, n=1). Among them, 15 patients (88.2%) had intestinal malrotation. Two patients with normal rotation had either right sided or dorsal sided SMV., Conclusion: Situs ambiguus was commonly associated with intestinal malrotation with a variable SMA-SMV relationship. Reversal of the mesenteric vascular relationship was observed in situs inversus with normal rotation, not excluding the possibility of intestinal malrotation., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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21. Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review.
- Author
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Wang C, Zhu X, Guo GH, Shu X, Wang J, Zhu Y, Li B, and Wang Y
- Subjects
- Adult, Arteriovenous Fistula complications, Arteriovenous Fistula surgery, Embolization, Therapeutic, Endoscopy, Gastrointestinal, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Humans, Male, Mesenteric Artery, Superior surgery, Mesenteric Veins surgery, Tomography, X-Ray Computed, Arteriovenous Fistula diagnostic imaging, Gastrointestinal Hemorrhage diagnostic imaging, Mesenteric Artery, Superior abnormalities, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging
- Abstract
Superior mesenteric arteriovenous fistula (SMAVF) is a rare vascular disorder usually following penetrating abdominal trauma or gastrointestinal surgery. Percutaneous endovascular treatment such as embolization, has been widely used to treat this disease. We report a patient, who was presented with melena at the onset of his symptoms, then an acute hematemesis in shock. A SMAVF was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful emergency endoscopic variceal ligation (EVL) to stop bleeding. Then the patient received fistula embolization with covered stent.
- Published
- 2016
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22. Morphology of congenital portosystemic shunts involving the left colic vein in dogs and cats.
- Author
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White RN and Parry AT
- Subjects
- Animals, Female, Male, Mesenteric Veins abnormalities, Retrospective Studies, Vena Cava, Inferior abnormalities, Cats abnormalities, Dogs abnormalities, Portal System abnormalities, Vascular Malformations veterinary
- Abstract
Objective: To describe the anatomy of congenital portosystemic shunts involving the left colic vein in dogs and cats., Methods: Retrospective review of a consecutive series of dogs and cats managed for congenital portosystemic shunts. For inclusion a shunt involving the left colic vein with recorded intraoperative mesenteric portovenography or computed tomography angiography along with direct gross surgical observations at the time of surgery was required., Results: Six dogs and three cats met the inclusion criteria. All cases had a shunt which involved a distended left colic vein. The final communication with a systemic vein was variable; in seven cases (five dogs, two cats) it was via the caudal vena cava, in one cat it was via the common iliac vein and in the remaining dog it was via the internal iliac vein. In addition, two cats showed caudal vena cava duplication., Clinical Significance: The morphology of this shunt type appeared to be a result of an abnormal communication between either the left colic vein or the cranial rectal vein and a pelvic systemic vein (caudal vena cava, common iliac vein or internal iliac vein). This information may help with surgical planning in cases undergoing shunt closure surgery., (© 2016 British Small Animal Veterinary Association.)
- Published
- 2016
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23. [Extrahepatic shunt. Unusual cause of hepatic encephalopathy].
- Author
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González-Partida I, Hernández Conde M, Llop Herrera E, Oliva del Río B, López Gómez M, Calleja Panero JL, and Abreu García L
- Subjects
- Aged, Female, Hepatic Encephalopathy diagnosis, Humans, Mesenteric Veins diagnostic imaging, Vascular Fistula complications, Vena Cava, Inferior diagnostic imaging, Hepatic Encephalopathy etiology, Mesenteric Veins abnormalities, Vascular Fistula diagnostic imaging, Vena Cava, Inferior abnormalities
- Published
- 2015
24. Combined transhepatic portal venous and transarterial treatment of superior mesenteric arteriovenous fistula in a patient with cirrhosis.
- Author
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Landi F, Ronot M, Abdel-Rehim M, Sibert A, Bissonnette J, Soubrane O, and Vilgrain V
- Subjects
- Arteriovenous Fistula diagnostic imaging, Hemostatics administration & dosage, Hepatic Artery diagnostic imaging, Humans, Liver Cirrhosis diagnostic imaging, Male, Mesenteric Arteries diagnostic imaging, Mesenteric Artery, Superior, Mesenteric Veins diagnostic imaging, Middle Aged, Portal Vein diagnostic imaging, Radiography, Treatment Outcome, Arteriovenous Fistula complications, Arteriovenous Fistula therapy, Embolization, Therapeutic methods, Liver Cirrhosis complications, Mesenteric Arteries abnormalities, Mesenteric Veins abnormalities
- Published
- 2015
- Full Text
- View/download PDF
25. Mesenteric-reno-caval shunt in an aged dog.
- Author
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Specchi S, Pey P, Javard R, Caron I, and Bertolini G
- Subjects
- Animals, Male, Mesenteric Veins diagnostic imaging, Renal Veins diagnostic imaging, Tomography, X-Ray Computed veterinary, Vascular Malformations diagnostic imaging, Vena Cava, Inferior diagnostic imaging, Dogs abnormalities, Mesenteric Veins abnormalities, Renal Veins abnormalities, Vascular Malformations veterinary, Vena Cava, Inferior abnormalities
- Published
- 2015
- Full Text
- View/download PDF
26. Ischemic colitis due to a mesenteric arteriovenous malformation in a patient with a connective tissue disorder.
- Author
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Poullos PD, Thompson AC, Holz G, Edelman LA, and Jeffrey RB
- Subjects
- Adult, Angiography methods, Arteriovenous Malformations complications, Arteriovenous Malformations surgery, Colitis, Ischemic etiology, Colitis, Ischemic surgery, Diagnosis, Differential, Female, Humans, Magnetic Resonance Angiography methods, Marfan Syndrome surgery, Mesenteric Arteries surgery, Mesenteric Veins surgery, Treatment Outcome, Arteriovenous Malformations diagnosis, Colitis, Ischemic diagnosis, Marfan Syndrome diagnosis, Mesenteric Arteries abnormalities, Mesenteric Veins abnormalities
- Abstract
Ischemic colitis is a rare, life-threatening, consequence of mesenteric arteriovenous malformations. Ischemia ensues from a steal phenomenon through shunting, and may be compounded by the resulting portal hypertension. Computed tomographic angiography is the most common first-line test because it is quick, non-invasive, and allows for accurate anatomic characterization. Also, high-resolution three-dimensional images can be created for treatment planning. Magnetic resonance angiography is similarly sensitive for vascular mapping. Conventional angiography remains the gold standard for diagnosis and also allows for therapeutic endovascular embolization. Our patient underwent testing using all three of these modalities. We present the first reported case of this entity in a patient with a vascular connective tissue disorder.
- Published
- 2014
- Full Text
- View/download PDF
27. A rare congenital extrahepatic portosystemic shunt affecting the inferior mesenteric vein, inferior vena cava, and left ovarian vein.
- Author
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Takeuchi H, Takeda Y, Takahashi M, Hayashi S, Fukuzawa Y, and Nakano T
- Subjects
- Aged, 80 and over, Cadaver, Dissection, Female, Humans, Mesenteric Veins abnormalities, Ovary blood supply, Portal Vein abnormalities, Vascular Malformations diagnosis, Vena Cava, Inferior abnormalities
- Abstract
Purpose: To observe a case of congenital extrahepatic portosystemic shunt and discuss it from the embryological and clinical viewpoints., Methods: An 85-year-old female cadaver was employed for a dissection course at Aichi Medical University in 2009., Results: There was no evidence of liver cirrhosis macroscopically or microscopically. A portosystemic shunt was observed that involved communication between the inferior mesenteric vein, inferior vena cava (IVC), and left ovarian vein by a single Y-shaped shunt vessel., Conclusions: To the best of our knowledge, this is the first reported case of the above-mentioned three veins being connected by a single Y-shaped shunt vessel. Considering the other venous diameters, the shunt appeared to flow into the splenic vein and IVC. It cannot be denied that this shunt may have led to hepatic encephalopathy, although the shunt effect may have been minimal. Embryological development of IVC appears to occur close to the plexus of anastomosing vitelline veins, forming the portal vein.
- Published
- 2014
- Full Text
- View/download PDF
28. Circumportal pancreas: a clinicoradiological and embryological review.
- Author
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Arora A, Velayutham P, Rajesh S, Patidar Y, Mukund A, and Bharathy KG
- Subjects
- Humans, Mesenteric Veins abnormalities, Pancreas embryology, Pancreas surgery, Pancreaticoduodenectomy, Portal Vein abnormalities, Prevalence, Diagnostic Imaging, Pancreas abnormalities
- Abstract
Circumportal pancreas is a congenital fusion anomaly of the pancreas where the pancreatic tissue from the uncinate process, anomalously encases the portal vein and/or the superior mesenteric vein. Depending upon the level of the pancreatic annulus the variant can be classified into three subtypes-suprasplenic, infrasplenic or mixed; and each subtype exhibits either an anteportal or retroportal main pancreatic duct. Limited literature is available on this intriguing anomaly primarily because of its relatively low prevalence in humans (published prevalence rates vary from 0.2 to 2.5 %), probable lack of awareness among medical professionals and its generally symptomless course. In an attempt to appraise the embryological basis, clinicoradiological manifestations and potential surgical implications of circumportal pancreas, literature published in English was searched using PubMed and information collated so as to provide up-to-date information on this relatively understudied entity. The anomaly by itself remains innocuous but its preoperative recognition in those undergoing pancreatic resection bears decisive influence on planning and selecting apposite surgical resection planes as inadvertent duct injury can lead to pancreatic fistula.
- Published
- 2014
- Full Text
- View/download PDF
29. Arteriovenous fistula in the inferior mesenteric territory.
- Author
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Carbonell S, Ortiz S, Enriquez P, and Lluis F
- Subjects
- Aged, Humans, Male, Radiography, Arteriovenous Fistula diagnostic imaging, Arteriovenous Fistula therapy, Mesenteric Artery, Inferior abnormalities, Mesenteric Veins abnormalities
- Published
- 2014
- Full Text
- View/download PDF
30. Congenital inferior mesenteric arteriovenous malformation presenting with ischemic colitis: endovascular treatment.
- Author
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Justaniah AI, Molgaard C, Flacke S, Barto A, and Iqbal S
- Subjects
- Adult, Angiography, Digital Subtraction, Arteriovenous Fistula diagnosis, Colitis, Ischemic diagnosis, Humans, Male, Mesenteric Artery, Inferior diagnostic imaging, Mesenteric Veins diagnostic imaging, Phlebography methods, Tomography, X-Ray Computed, Treatment Outcome, Arteriovenous Fistula therapy, Colitis, Ischemic therapy, Embolization, Therapeutic, Endovascular Procedures methods, Mesenteric Artery, Inferior abnormalities, Mesenteric Veins abnormalities
- Published
- 2013
- Full Text
- View/download PDF
31. Massive gastrointestinal bleeding secondary to superior mesenteric arteriovenous fistula.
- Author
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An T, Zhou S, Song J, Jiang T, Li X, and Wang W
- Subjects
- Adult, Angiography, Humans, Male, Tomography, X-Ray Computed, Arteriovenous Fistula complications, Gastrointestinal Hemorrhage etiology, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities
- Published
- 2013
- Full Text
- View/download PDF
32. Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula.
- Author
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Garg D, Lopera JE, and Goei AD
- Subjects
- Adult, Arteriovenous Fistula diagnostic imaging, Endovascular Procedures, Female, Humans, Mesenteric Vascular Occlusion etiology, Portasystemic Shunt, Transjugular Intrahepatic, Radiography, Stents, Venous Thrombosis etiology, Arteriovenous Fistula therapy, Embolization, Therapeutic adverse effects, Mesenteric Artery, Superior abnormalities, Mesenteric Vascular Occlusion surgery, Mesenteric Veins abnormalities, Portal Vein, Venous Thrombosis surgery
- Abstract
Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome.
- Published
- 2013
- Full Text
- View/download PDF
33. Pancreaticoduodenectomy in portal annular pancreas: report of a case.
- Author
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Kobayashi S, Honda G, Kurata M, Okuda Y, and Tsuruta K
- Subjects
- Humans, Male, Mesenteric Veins abnormalities, Middle Aged, Pancreas surgery, Pancreatic Fistula prevention & control, Portal Vein abnormalities, Postoperative Complications prevention & control, Treatment Outcome, Adenocarcinoma surgery, Ampulla of Vater surgery, Common Bile Duct Neoplasms surgery, Pancreas abnormalities, Pancreas blood supply, Pancreaticoduodenectomy methods, Portal Vein surgery
- Abstract
Portal annular pancreas (PAP) is a rare anatomical anomaly in which the pancreatic parenchyma surrounds the superior mesenteric vein and portal vein (PV) annularly. This anomaly requires careful consideration in pancreatic resection. A case is presented and the technical issues are discussed. A 61-year-old female was referred to the hospital for suspected papilla Vater adenocarcinoma. Preoperative computed tomography showed that the PV was annularly surrounded by pancreatic parenchyma. Surgery revealed the uncinate process extended extensively behind the PV and fused with the pancreatic body. The pancreas was first divided above the PV, and it was divided again in the body after liberating the PV from pancreatic annulation. The postoperative course was uneventful without pancreatic fistula. It is safer to divide the pancreatic body on the left of the fusion between the uncinate process and the pancreatic body to reduce the risk of pancreatic fistula in pancreaticoduodenectomy for PAP.
- Published
- 2013
- Full Text
- View/download PDF
34. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia.
- Author
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Hussein M, Issa G, Muhsen S, and Haydar A
- Subjects
- Humans, Ileum surgery, Male, Middle Aged, Arteriovenous Fistula therapy, Embolization, Therapeutic, Ileum blood supply, Ischemia surgery, Mesenteric Artery, Superior abnormalities, Mesenteric Veins abnormalities, Postoperative Complications surgery
- Abstract
Superior mesenteric arteriovenous fistulas are rare, especially when iatrogenic in origin. Management of these fistulas can be surgical or endovascular. Endovascular embolisation is the preferred modality with a low rate of complications. Among the reported complications, bowel ischaemia is considered an unlikely occurrence. We report a case of a complex iatrogenic arterioportal fistula that was managed by endovascular embolisation and controlled through both its inflow and outflow, and was later complicated by bowel ischaemia.
- Published
- 2013
- Full Text
- View/download PDF
35. A rare case of incidental pancreatic arteriovenous malformation correctly diagnosed with MDCT.
- Author
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De Robertis Lombardi R, D'Onofrio M, Crosara S, Canestrini S, Demozzi E, and Pozzi Mucelli R
- Subjects
- Aged, Celiac Artery abnormalities, Celiac Artery diagnostic imaging, Diagnosis, Differential, Female, Humans, Incidental Findings, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Multidetector Computed Tomography, Pancreas blood supply, Portal Vein diagnostic imaging, Splenic Artery abnormalities, Splenic Artery diagnostic imaging, Arteriovenous Malformations diagnostic imaging, Pancreas abnormalities, Pancreas diagnostic imaging, Portal Vein abnormalities
- Abstract
Context: Pancreatic arteriovenous malformations are a rare entity that can be incidentally discovered during MDCT examinations., Case Report: We describe a rare case of asymptomatic arteriovenous malformation presenting at MDCT as a hypervascular mass in the pancreatic head., Conclusion: Pancreatic arteriovenous malformations are a rare entity, often asymptomatic, that can be correctly diagnosed by MDCT, especially with the use of specific electronic reconstructions.
- Published
- 2013
- Full Text
- View/download PDF
36. 3D for D3: role of imaging for right colectomy in a case with congenital superior mesenteric vein aneurysm and co-existing anomalous irrigation.
- Author
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Kiil S, Stimec BV, Spasojevic M, Fasel JH, and Ignjatovic D
- Subjects
- Adenocarcinoma complications, Adenocarcinoma surgery, Aged, Aneurysm etiology, Aneurysm surgery, Angiography methods, Cecal Neoplasms complications, Cecal Neoplasms surgery, Female, Follow-Up Studies, Humans, Iliac Vein abnormalities, Mesenteric Veins surgery, Preoperative Care, Tomography, X-Ray Computed, Treatment Outcome, Adenocarcinoma diagnosis, Aneurysm diagnosis, Cecal Neoplasms diagnosis, Colectomy methods, Echocardiography, Three-Dimensional methods, Mesenteric Veins abnormalities
- Abstract
Background: The D3 right colectomy for cancer requires dissection in the vicinity of the superior mesenteric vessels, which requires preoperative 3D imaging in these patients., Case Report: We present a patient with a caecum adenocarcinoma cancer which underwent D3 resection of the right colon, preceded by pre-operative MDCT with 2D multiplanar reconstruction and 3D volume rendering., Results: The dataset analysis revealed a rare congenital aneurysm of the superior mesenteric vein below the spleno-mesenteric confluence and a co-existing anomalous irrigation in the form of an ileo-mesenteric trunk. The surgical procedure was carried out as planned and the patient presents no signs of recurrence of the disease one year after the intervention., Conclusions: The case presented - with a rare and complicated vascular situs - illustrates particularly well that multimodal post-processing of the CT dataset for volume rendering allows proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and accomplishing the delicate operation, avoiding the surgical pitfalls and iatrogenic injuries., (Celsius.)
- Published
- 2013
37. Amelioration of high cardiac output and pulmonary hypertension by occlusion of congenital porto-systemic shunt.
- Author
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McKie PM, McCully RB, Kamath PS, Bower TC, McKusick MA, Lapyere AC, and Pereira NL
- Subjects
- Aged, Cardiac Output, High diagnosis, Female, Humans, Hypertension, Pulmonary diagnosis, Portasystemic Shunt, Transjugular Intrahepatic, Cardiac Output, High surgery, Hypertension, Pulmonary surgery, Mesenteric Veins abnormalities, Mesenteric Veins surgery, Vena Cava, Inferior abnormalities, Vena Cava, Inferior surgery
- Published
- 2012
- Full Text
- View/download PDF
38. Severe portopulmonary hypertension associated with an unusual pattern of abernethy malformation: three-dimensional computed tomography view.
- Author
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Caputo S and Manganiello CA
- Subjects
- Adult, Female, Humans, Hypertension, Pulmonary diagnostic imaging, Imaging, Three-Dimensional, Mesenteric Veins abnormalities, Portal Vein abnormalities, Tomography, X-Ray Computed methods, Vascular Malformations diagnostic imaging
- Published
- 2012
- Full Text
- View/download PDF
39. Adult intestinal malrotation: when things turn the wrong way.
- Author
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Palmer OP, Rhee HH, Park WG, and Visser BC
- Subjects
- Adult, Current Procedural Terminology, Digestive System Surgical Procedures, Duodenum blood supply, Duodenum surgery, Endosonography, Esophageal Neoplasms, Humans, Intestines abnormalities, Leiomyomatosis, Male, Mesenteric Veins abnormalities, Tomography, X-Ray Computed methods, Uterine Neoplasms, Varicose Veins diagnostic imaging, Varicose Veins surgery, Melena etiology
- Published
- 2012
- Full Text
- View/download PDF
40. Case 177: Congenital absence of the portal vein with hepatic adenomatosis.
- Author
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Asran MK, Loyer EM, Kaur H, and Choi H
- Subjects
- Adenoma diagnostic imaging, Contrast Media, Female, Gadolinium DTPA, Humans, Liver Neoplasms diagnostic imaging, Mesenteric Veins abnormalities, Middle Aged, Splenic Vein abnormalities, Vena Cava, Inferior abnormalities, Adenoma diagnosis, Liver Neoplasms diagnosis, Magnetic Resonance Imaging methods, Portal Vein abnormalities, Tomography, X-Ray Computed methods
- Published
- 2012
- Full Text
- View/download PDF
41. CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation.
- Author
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Taylor GA
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Duodenum, Female, Humans, Infant, Male, Reference Standards, Congenital Abnormalities diagnostic imaging, Digestive System Abnormalities complications, Intestine, Small abnormalities, Intestine, Small diagnostic imaging, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Background: Demonstration of the third duodenal segment (D3) in retroperitoneal location has been recently proposed as a method for excluding malrotation., Objective: This study was performed to determine whether a retroperitoneal third duodenal segment can reliably exclude malrotation., Materials and Methods: CTs of 38 patients with proven malrotation and 100 patients without malrotation were evaluated for the location of the duodenum/proximal small bowel, and the relationship of the superior mesenteric vein (SMV) to superior mesenteric artery (SMA)., Results: The D3 segment was in normal retroperitoneal location in 100% of control patients, compared to 2.5% or (1 of 38) of patients with malrotation. Nine of 11 patients (91%) with malrotation imaged prior to surgery had the proximal bowel in an abnormal location, while all 100 control patients had it in a normal location. The SMV was in normal relationship to the SMA in 11/38 patients (29%) with malrotation, compared to 79% of normal controls. In 10 controls, a branch of the SMV was partially wrapped around the SMA, potentially mimicking partial mesenteric volvulus., Conclusion: A retroperitoneal location of the D3 segment makes the diagnosis of malrotation unlikely but not impossible. Additional imaging of the duodenojejunal junction or cecum may be necessary to reliably exclude intestinal malrotation.
- Published
- 2011
- Full Text
- View/download PDF
42. Parapagus conjoined twins with unilateral mesenteric venous outflow.
- Author
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Mattix K, Healey PJ, Sawin RS, and Waldhausen JH
- Subjects
- Anastomosis, Surgical, Female, Humans, Infant, Newborn, Mesenteric Arteries abnormalities, Mesenteric Veins surgery, Splenic Vein surgery, Twins, Conjoined pathology, Failure to Thrive etiology, Hypoglycemia etiology, Mesenteric Veins abnormalities, Postoperative Complications, Twins, Conjoined surgery
- Abstract
This case presents a complication of attempted separation of parapagus conjoined twins, related to loss of an intact mesenteric-portal venous axis. Despite known lack of a superior mesenteric artery in the right twin, initial evaluation in the operating room suggested that separation was possible. After hepatic division, however, it became apparent that the mesenteric drainage was not separable; and the operation was aborted. Subsequently, significant growth failure and hypoglycemia were noted in the right twin. The situation was corrected by creating a shunt to reinstitute mesenteric flow to the right twin's liver and separating the twin's mesenteric drainage. One year postoperatively, both twins are independently nourishing themselves and have been free from hospitalization with stable glucoses., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
43. Congenital absence of portal vein with large inferior mesenteric-caval shunt.
- Author
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Gadodia A, Sharma R, Kandpal H, and Prashad R
- Subjects
- Female, Humans, Hyperandrogenism complications, Hyperinsulinism complications, Liver Function Tests, Portal Vein diagnostic imaging, Tomography, X-Ray Computed, Ultrasonography, Young Adult, Arteriovenous Malformations diagnostic imaging, Mesenteric Veins abnormalities, Portal Vein abnormalities, Vena Cava, Inferior abnormalities
- Published
- 2011
44. Portal-systemic shunt between the inferior mesenteric vein and inferior vena cava in a patient with hepatic encephalopathy: successful occlusion by balloon-occluded retrograde transvenous obliteration.
- Author
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Kakizawa H, Toyota N, Hieda M, Ishikawa M, Tanitame K, Tani C, Okazaki A, Takaki S, Aikata H, Chayama K, and Awai K
- Subjects
- Aged, Humans, Male, Balloon Occlusion methods, Hepatic Encephalopathy therapy, Mesenteric Veins abnormalities, Vena Cava, Inferior abnormalities
- Abstract
A large shunt between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is a rare type of portosystemic shunt in patients with hepatic encephalopathy. We report a patient with hepatic encephalopathy due to a large IMV-IVC shunt who was successfully treated by balloon-occluded retrograde transvenous obliteration. The procedure involved a combination of 11 metallic coils and 5 ml of 5% ethanolamine oleate with iopamidol as the sclerosing agent. After complete obliteration of the shunt, his symptoms disappeared. At 2-years follow-up he was free of clinical symptoms, the size of his liver had slightly increased, and his liver function was preserved.
- Published
- 2011
45. Management and classification of type II congenital portosystemic shunts.
- Author
-
Lautz TB, Tantemsapya N, Rowell E, and Superina RA
- Subjects
- Abnormalities, Multiple classification, Abnormalities, Multiple surgery, Adolescent, Child, Child, Preschool, Endovascular Procedures methods, Female, Hepatic Encephalopathy classification, Hepatic Encephalopathy surgery, Humans, Hyperammonemia classification, Hyperammonemia surgery, Infant, Ligation methods, Male, Mesenteric Veins abnormalities, Mesenteric Veins surgery, Portal Vein surgery, Splenic Vein abnormalities, Splenic Vein surgery, Syndrome, Vascular Fistula classification, Vascular Fistula congenital, Portal System abnormalities, Portal System surgery, Portal Vein abnormalities, Vascular Fistula surgery
- Abstract
Background: Congenital portosystemic shunts (PSS) with preserved intrahepatic portal flow (type II) present with a range of clinical signs. The indications for and benefits of repair of PSS remain incompletely understood. A more comprehensive classification may also benefit comparative analyses from different institutions., Methods: All children treated at our institution for type II congenital PSS from 1999 through 2009 were reviewed for presentation, treatment, and outcome., Results: Ten children (7 boys) with type II PSS were identified at a median age of 5.5 years. Hyperammonemia with varying degrees of neurocognitive dysfunction occurred in 80%. The shunt arose from a branch of the portal vein (type IIa; n = 2), from the main portal vein (type IIb; n = 7), or from a splenic or mesenteric vein (type IIc; n = 1). Management included operative ligation (n = 6), endovascular occlusion (n = 3), or a combined approach (n = 1). Shunt occlusion was successful in all cases. Serum ammonia decreased from 130 ± 115 μmol/L preoperatively to 31 ± 15 μmol/L postoperatively (P = .03). Additional benefits included resolution of neurocognitive dysfunction (n = 3), liver nodules (n = 1), and vaginal bleeding (n = 1)., Conclusion: Correction of type II PSS relieves a wide array of symptoms. Surgery is indicated for patients with clinically significant shunting. A refined classification system will permit future comparison of patients with similar physiology., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
46. Radical esophagectomy for a patient with reversed intestinal rotation and complicated vascular anomalies in the abdomen.
- Author
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Makino I, Ninomiya I, Fujimura T, Kinoshita J, Nakamura K, Oyama K, Fujita H, Fushida S, Kayahara M, and Ohta T
- Subjects
- Angiography, Diagnosis, Differential, Esophageal Neoplasms complications, Follow-Up Studies, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Vascular Malformations diagnostic imaging, Esophageal Neoplasms surgery, Esophagectomy methods, Hepatic Artery abnormalities, Mesenteric Veins abnormalities, Splenic Vein abnormalities, Vascular Malformations complications
- Abstract
We report a patient of lower esophageal carcinoma with reversed intestinal rotation and major vascular anomalies including pre-duodenal pre-pancreatic portal vein, absence of the confluence of the splenic vein with the superior mesenteric vein, and deficiency of the common hepatic artery. We performed subtotal esophagectomy with three-field lymphadenectomy following reconstruction with the stomach. The postoperative course was uneventful. This might be the first case that had such complicated anatomical anomalies and radical esophagectomy was performed. As we had preoperatively recognized these anatomical anomalies on radiographic examinations, we could successfully perform esophagectomy and reconstruction without any complications.
- Published
- 2011
- Full Text
- View/download PDF
47. Spontaneous meso-portal shunt following orthotopic liver transplantation in a child.
- Author
-
Vannevel G, Clapuyt P, Reding R, and Menten R
- Subjects
- Child, Female, Hepatic Artery diagnostic imaging, Humans, Mesenteric Veins diagnostic imaging, Ultrasonography, Arteriovenous Fistula diagnostic imaging, Arteriovenous Fistula etiology, Hepatic Artery abnormalities, Liver Transplantation adverse effects, Liver Transplantation diagnostic imaging, Mesenteric Veins abnormalities
- Abstract
Post-transplant children are regularly followed by colour Doppler US exam. Liver parenchyma, biliary tract and portal, subhepatic and arterial vascularisation are checked. We observed a post-transplant child with spontaneous meso-portal bypass after portal vein thrombosis (PVT). After orthotopic liver transplantation (OLT), PVT is frequently observed. When it occurs early (before 3 weeks), it has been identified as a cause of graft failure. On the other hand, late PVT (after 3 weeks) can be extremely well-tolerated, with cavernous transformation of the portal vein and formation of hepatopetal collaterals that deliver blood to the liver. However, extrahepatic portal hypertension (EHPH) and its related complications can develop. Cavernoma transformation is usually seen, but spontaneous shunt is not yet described in transplant patients. Distinction from the classic cavernoma can be achieved by the depiction of a single transcapsular vessel. This bypass partially corrects the EHPH. However it was decided to completely prevent shunt development by performing a surgical mesenterico-left portal vein bypass.
- Published
- 2010
- Full Text
- View/download PDF
48. Congenital extrahepatic portosystemic shunts (CEPS) type Ib: MDCT finding.
- Author
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Caruso S, Riva S, Spada M, Luca A, and Gridelli B
- Subjects
- Cholestasis, Intrahepatic complications, Cholestasis, Intrahepatic congenital, Cholestasis, Intrahepatic diagnostic imaging, Cholestasis, Intrahepatic genetics, Chromosomes, Human, Pair 8, Clinical Enzyme Tests, Female, Heart Septal Defects, Ventricular complications, Heart Septal Defects, Ventricular genetics, Heart Septal Defects, Ventricular surgery, Humans, Infant, Liver diagnostic imaging, Liver Failure diagnostic imaging, Liver Failure etiology, Liver Failure genetics, Mesenteric Veins diagnostic imaging, Portal System diagnostic imaging, Portography, Splenic Vein abnormalities, Splenic Vein diagnostic imaging, Tomography, Trisomy, Vena Cava, Inferior abnormalities, Vena Cava, Inferior diagnostic imaging, Liver abnormalities, Liver blood supply, Mesenteric Veins abnormalities, Portal System abnormalities
- Published
- 2010
- Full Text
- View/download PDF
49. Chronic recurrent crampy abdominal pain owing to partial intestinal malrotation.
- Author
-
van den Hoven I and Roumen RM
- Subjects
- Abdomen, Female, Humans, Ileocecal Valve surgery, Intestines surgery, Mesenteric Veins surgery, Middle Aged, Syndrome, Tomography, X-Ray Computed, Treatment Outcome, Abdominal Pain etiology, Intestines abnormalities, Mesenteric Veins abnormalities, Mesenteric Veins diagnostic imaging
- Published
- 2010
- Full Text
- View/download PDF
50. Portosystemic encephalopathy due to mesoiliac shunt in a patient without cirrhosis.
- Author
-
Ali S, Stolpen AH, and Schmidt WN
- Subjects
- Female, Hepatic Encephalopathy physiopathology, Hepatic Encephalopathy surgery, Humans, Iliac Vein surgery, Magnetic Resonance Imaging, Mesenteric Veins surgery, Middle Aged, Hepatic Encephalopathy etiology, Iliac Vein abnormalities, Mesenteric Veins abnormalities
- Abstract
Hepatic encephalopathy most commonly occurs in patients with cirrhosis and end-stage liver disease, however, the disorder can also occur in the presence of intrahepatic or extrahepatic shunts when the intrahepatic circulation is effectively bypassed. The majority of extrahepatic shunts described to date develop between a mesenteric vein and inferior vena cava. Herein we report a novel case of a superior mesenteric vein to left internal iliac vein shunt that led to hepatic encephalopathy in a 57-year-old woman with no apparent underlying liver disorder. The patient presented with confusion, disorientation, and hyperammonemia. Workup for parenchymal liver disease was negative and liver biopsy findings did not show significant liver disease. Magnetic resonance imaging revealed a serpiginous 1-cm-wide shunt that diverted superior mesenteric vein blood from the portal confluence to the left internal iliac vein. Surgical closure of the shunt led to marked improvement of the patient with the resolution of hepatic encephalopathy. This report is the first description of a portosystemic shunt, likely congenital, linking these 2 vessels resulting in clinically significant hepatic encephalopathy. The findings emphasize that abdominal and pelvic imaging should be considered in patients with signs of hepatic encephalopathy that have none to minimal hepatic disease.
- Published
- 2010
- Full Text
- View/download PDF
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