Eosinophils are only a small minority of peripheral blood leucocytes and, in normal subjects, most are found in the tissues of the lung and gastrointestinal tract. Peripheral blood eosinophilia is occurred by various causes, allergic diseases, parasite infection, clonal disorder, and drug. Moderate to severe eosinophilia may be caused by the idiopathic hypereosinophilic syndrome (HES), but the commonest cause of eosinophilia worldwide is helminthic infection and, in industrialized nations, atopic disease. Whatever the cause for the eosinophilia, in certain circumstances the eosinophils produce damage to various organs by activation of eosinophils, thrombotic events, release of eosinophil granule contents, and deposition of eosinophil proteins. Clinical manifestations are characterized by thromboembolic events of the involved organ, such as the heart, lungs, or nervous system. To our knowledge, the association between hypereosinophilia and intraabdominal multivessel (portal, splenic and superior mesenteric vein) thrombosis has never previously been reported. Thus, we report a case with portal, splenic and superior mesenteric venous thrombosis simultaneously with disseminated intravascular coagulapathy in the patient with hypereosinophilia.
Developed Countries ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Heart ; Helminths ; Humans ; Hypereosinophilic Syndrome ; Lung ; Mesenteric Veins* ; Necrosis* ; Nervous System ; Parasites ; Portal Vein* ; Splenic Vein* ; Thrombosis* ; Venous Thrombosis

Portal pyelophlebitis is extremly rare in its incidence and associated with high mortality. It usually occurs secondary to infection in the region drained by the portal systems or in the structure contiguous to the portal vein. We report two cases of septic thrombophlebitis of the portal and superior mesenteric veins caused by acute appendicitis. Both the patients had good outcomes after medical and surgical treatment. An early diagnosis and treatment are vital for the good treatment results.
Appendicitis* ; Early Diagnosis ; Humans ; Incidence ; Mesenteric Veins ; Mortality ; Portal System ; Portal Vein ; Thrombophlebitis

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.
Abdominal Pain ; Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Diarrhea ; Drainage ; Humans ; Intraabdominal Infections ; Jaundice ; Mesenteric Veins ; Portal System ; Portal Vein ; Thrombosis

The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.
Abdomen ; Adult ; Animals ; Cats ; Colon ; Colon, Transverse ; Drug Therapy ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Female ; Humans ; Male ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatectomy ; Physical Examination ; Portal Vein ; Recurrence ; Splenic Vein ; Stomach

Anomalies of the fetal venous system are rare. Major portion of fetal venous anomalies are malformation of umbilical vein and ductus venosus. Abnormal umbilico-systemic shunt, bypassing the ductus venosus makes direct connection between the high-pressure umbilical system and the low-pressure systemic system. And it makes adverse to the fetal hemodynamics. Fetal hemodynamic distress may induce fetal growth retardation, hepatomegaly, cardiomegaly, hydrops fetalis and fetal death. We report a case of non-immune hydrops fetalis which was associated with abnormal umbilical vein pathway. Our patient had bifurcated umbilical veins. Main branch of umbilical vein was drained directly to the left internal iliac vein and another branch was drained to the portal vein. After birth, extrahepatic shunt through main branch of umbilical vein that bypassed the portal system was persisted and thrombocytopenia was combined due to consumption in thrombus of a dilated anomalous umbilical vein. Later this case was diagnosed as Noonan syndrome with a genetic testing.
Cardiomegaly ; Fetal Death ; Fetal Growth Retardation ; Fetus ; Genetic Testing ; Hemodynamics ; Hepatomegaly ; Humans ; Hydrops Fetalis* ; Iliac Vein ; Noonan Syndrome* ; Parturition ; Portal System ; Portal Vein ; Thrombocytopenia ; Thrombosis ; Umbilical Veins ; Vascular Malformations

Pylephlebitis is defined as an inflammation of the portal system, which is a rare but dreaded complication of intra-abdominal inflammatory processes. In the past it was observed as a sequela of neglected or complicated appendicitis. With earlier diagnosis, modern surgical technique and antibiotics, the incidence has declined even further. In addition, thrombosis in portal system (pylethrombosis) can complicate the pylephlebitis, followed by obstruction of the portal system, leading to portal hypertension in the late stage. Proper recognition of early thrombosis and an accompanying intra-abdominal inflammatory process should arouse the suspicion of septic thrombophlebitis and lead to the early institution of adequate therapy to prevent the almost universally fatal outcome. We report the case of woman who had pylephlebitis and presented with fever of unknown origin, probably associated with acute appendicitis.
Anti-Bacterial Agents ; Appendicitis ; Diagnosis ; Fatal Outcome ; Female ; Fever of Unknown Origin* ; Fever* ; Humans ; Hypertension, Portal ; Incidence ; Inflammation ; Portal System ; Portal Vein* ; Thrombophlebitis* ; Thrombosis

Budd-Chiari Syndrome (BCS) is unusual form of portal hypertension caused by occlusion of the hepatic venous outflow and it is often frequently complicated by inferior vena cava (IVC) occlusion. It may vary in its presentation from very mild symptomatology, suggestive of a viral illness, to a very acute form with a fulminant course. In the cases of BCS caused by occlusion of IVC and hepatic vein, none of the standard portal-systemic shunt can be utilized for satisfactory decompression of the liver. We have experienced two cases of BCS, 43 year-old male and 40 year-old male patients, caused by hepatic vein thrombosis associated thrombosis of the IVC. Cavoatrial shunt using Dacron graft and interposition graft between portal vein to cavoatrial graft were performed. Combined porto-cavo-atrial bypass that decompress both the portal system and IVC has been effective in relieving BCS caused by occlusion of hepatic vein with IVC.
Adult ; Budd-Chiari Syndrome* ; Decompression ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Male ; Polyethylene Terephthalates ; Portal System ; Portal Vein ; Thrombosis ; Transplants ; Vena Cava, Inferior

Portal hypertension can arise from any condition interfering with normal blood flow at any level within the portal system. Herein, we presented two uncommon cases of the portal hypertension and its treatment with brief literature review. A 71-year-old man who underwent right hemihepatectomy revealed a tumor recurrence adjacent to the inferior vena cava (IVC). After radiofrequency ablation (RFA) with lymph node dissection, he was referred for abdominal distension. The abdomen computed tomography scan showed severe ascites with a narrowing middle hepatic vein (MHV) and IVC around the RFA site. After insertion of two stents at the IVC and MHV, the ascites disappeared. Another 73-year-old man underwent right trisectionectomy of liver and segmental resection of the portal vein (PV). After operation, he underwent conservative management due to continuous abdominal ascites. The abdomen computed tomography scan showed severe ascites with obliteration of the left PV. After insertion of stent, the ascites disappeared. A decrease of the pressure gradient between the PV and IVC is one of the important treatment strategies for portal hypertension. Vascular stent is useful in the reduction of pressure gradient and thus, can be a treatment option for portal hypertension.
Abdomen ; Aged ; Ascites ; Catheter Ablation ; Constriction, Pathologic ; Hepatic Veins ; Humans ; Hypertension, Portal* ; Liver ; Lymph Node Excision ; Portal System ; Portal Vein ; Recurrence ; Stents ; Vena Cava, Inferior

PURPOSE: Studies of liver anatomy have developed alongside clinical achievements, as these types of research complement each other. The aim of this study is to determine whether or not the portal vein branches (P4d) in 'Nagino's trisectionectomy' exist, and to examine their characteristics using cadaver dissection. METHODS: From April 2012 to July 2012, 31 adult cadavers were delicately dissected. We defined a 'NewGP' as an extra glissonian pedicle (GP) other than the traditional GPs that supply segments II, III, IVa, and IVb in the ordinary direction, and anatomically located superior to the umbilical fissure (UF). RESULTS: We identified 'NewGPs' based on the UF and UF vein. The incidence of 'NewGPs' was 30/31 (96.8%). The diameter of the 'NewGPs' ranged from 3.5 to 5.6 mm, which was not significantly different from that of traditional GPs (II-, III-, or IV-GP), which have diameters ranging from 3.7 to 9.7 mm. CONCLUSION: We think that the P4d in 'Nagino's trisectionectomy' correspond to the 'IVa NewGP' and the additional pedicle. We believe the clinical significance of the 'NewGP' is to complement the traditional II, III, IVa, and IVb pedicles in supplying the liver.
Adult ; Cadaver* ; Complement System Proteins ; Humans ; Incidence ; Liver* ; Portal Vein ; Veins

Extensive visceral vein thrombosis, including the femoral vein, iliac vein, superior mesenteric vein, splenic vein and portal vein, is an uncommon type of thrombosis that is associated with significant mortality and morbidity. Making an early diagnosis and adequate management are very important. We present here the case of a 39-year-old woman with extensive visceral vein thrombosis and complicated small bowel necrosis and perforation. She had no known prothrombotic conditions, but the laboratory findings showed an elevated level of factor VIII. The patient's condition improved without complication after resection of the infarcted and perforated small bowel along with immediate postoperative anticoagulant therapy. On the follow up, the size of the thrombosis was decreased and there was no complication.
Adult ; Early Diagnosis ; Factor VIII ; Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Iliac Vein ; Mesenteric Veins ; Necrosis ; Portal Vein ; Splenic Vein ; Thrombosis ; Veins ; Venous Thrombosis