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Radiological and surgical differences between congenital end-to-side (Abernethy malformation) and side-to-side portocaval shunts.
- Source :
-
Journal of pediatric surgery [J Pediatr Surg] 2020 Sep; Vol. 55 (9), pp. 1897-1902. Date of Electronic Publication: 2020 Feb 01. - Publication Year :
- 2020
-
Abstract
- Objective: Distinguishing retrohepatic end-to-side portocaval shunts (ES-PCS) and side-to-side portocaval shunts (SS-PCS) can be difficult, but it is essential for determining the treatment strategy. Our experience with retrohepatic PCS is analyzed.<br />Methods: Since 2007, 9 children (5/9 ES-PCS and 4/9 SS-PCS) were surgically treated. Radiology studies included Doppler-ultrasound, CT/MRI and angiography/occlusion test (8/9).<br />Results: CT in 5/5 ES-PCS revealed the portal vein (PV) entering the left side of the vena cava with a uniform shape. 4/4 SS-PCS showed aneurysmal PV containing the origin of the main intrahepatic portal branches (IHPB) entering the cava anterior aspect or slightly to the right with a variable length (from long to short/wide). ES-PCS anatomy showed caudate lobe absence with the fistula entering the left cava aspect free of parenchyma, but anterior through the caudate lobe in SS-PCS. With the angiography/occlusion test, the IHPB was undeveloped in ES-PCS (portal pressure > 38 mmHg) and hypoplasic in SS-PCS (portal pressure < 25 mmHg). ES-PCS treatment included: 1/5 hepatectomy and 4/5 definitive banding (one by laparoscopy); while in SS-PCS: 1/4 liver transplantation, 2/4 1-step closure (one by laparoscopy), and 1/4 definitive banding.<br />Conclusion: Fistula shape, cava relationship, IHPB and portal pressures differ between the two shunt types. A question arises regarding the need for secondary complete closure after banding.<br />Level of Evidence: Level IV.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Child
Child, Preschool
Female
Fistula diagnostic imaging
Fistula surgery
Humans
Male
Retrospective Studies
Portal Vein abnormalities
Portal Vein diagnostic imaging
Portal Vein surgery
Vascular Malformations diagnostic imaging
Vascular Malformations surgery
Vena Cava, Inferior abnormalities
Vena Cava, Inferior diagnostic imaging
Vena Cava, Inferior surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1531-5037
- Volume :
- 55
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of pediatric surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32067808
- Full Text :
- https://doi.org/10.1016/j.jpedsurg.2020.01.053