PURPOSE: To describe the CT findings of portal vein aneurysm in eight patients. MATERIALS AND METHODS: Allpatients included in this study (two men and six women) under went CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined thelocation, shape, size, and characteristics of the lesions, and the presence or ab-sence of portal vein anomaly. RESULTS: S even patients had intrahepatic portal vein aneurysm (at the umbilical por-tion of the left portal veinin five patients, between the transverse and umbilical por-tion of the left portal vein in one, and at thebifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal veinaneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions werecyst-shaped in seven cases and saccular in one, and showed well - circum scribed, markedly enhanced mass, whichcommunicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the rightanterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in threepatients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portalvein, and in one, the umbilical portion of the left portal vein was located to the right of the Cantlie line. CONCLUSION: CT examination can help reveal portal vein aneurysm by detectinga well - circumscribed, markedlyenhanced mass which communicates with the portal vein and/or gives off major branches.
Aneurysm* ; Humans ; Hypertension, Portal ; Male ; Portal Vein* ; Splenic Vein

Acute gastric variceal bleeding is one of the most serious complications in portal hypertension, and is associated with high mortality and morbidity. Endoscopic variceal obturation (EVO) using Histoacryl(R) (n-butyl-2-cyanoacrylate) has been accepted as an effective hemostatic procedure in acute gastric variceal bleeding. However, EVO is not a widely performed because of technical difficulties and complications such as mucosal ulceration, perforation, and systemic embolism. Herein, we report a patient who developed hepatic failure caused by portal vein occlusion by Histoacryl(R) injection for management of gastric variceal bleeding.
Embolism ; Esophageal and Gastric Varices* ; Humans ; Hypertension, Portal ; Liver Failure ; Mortality ; Portal Vein* ; Splenic Vein* ; Ulcer

Splenoportography has been proved as a useful method for the evaluation of circulatory distrubances in portalhypertension. Authors analyzed the various aspects of these disturbances on splenoportography in 22 cases thatwere performed under the clinical suspicion of portal hypertension during recent 6 years, from May, 1976 to July,1982 at the Department of Radiology, National Medical Center. The results were as follows; 1. Liver cirrhosis wasthe most frequent cause of intrahepatic obstruction type in portal hypertenstion (86%). 2. The portal pressure wasmore than 400 mmH2O in 67% of the cases (range; 300-540 mmH2O). 3. In the majority of the cses, the higher theportal pressure was, the more dilated splenic and portal veins were. The diameter of portal vein was more than15mm in 79%, more than 21 mm in 47% of the cases (range; 10-26mm). The diameter of splenic vein was more than 15mmin 48% of the cases (range; 7-23mm). Especially the diameter of splenic vein was larger than that of portal veinin 20% of the cases. 4. There was no definite correlation between the development of collateral circulation andthe diameter of splenic and portal veins. 5. The filling of collateral circulation was definite sign of portalhypertenstion, though not regular. In portal hypertension, the collateral circulation was formed via coronary vein(91%), short gastric vein (64%), inferior mesenteric vein(36%). 6. Splenic-hilum time was delayed in 64% of thecases. Intrahepatic portal vein emptying time was more than 6 seconds in all the cases. 7. Most of the cases (91%)could be diagnosed as portal hypertension with vasculogram and hepatogram.
Collateral Circulation ; Hypertension, Portal ; Liver Cirrhosis ; Methods ; Portal Pressure ; Portal Vein ; Portography ; Splenic Vein ; Veins

Splenic complications may occur during the course of pancreatitis, as the pancreas and spleen lie adjacent to each other. However, splenic complications associated with pancreatitis are rare, including splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. The management for subcapsular splenic hematoma with pancreatitis remains controversial. We report a case of a 51-year-old man with alcoholic pancreatitis and the rare complication of a large subcapsular splenic hematoma, which was managed conservatively with a good outcome.
Alcoholics ; Aneurysm, False ; Hematoma ; Humans ; Middle Aged ; Pancreas ; Pancreatitis ; Pancreatitis, Alcoholic ; Spleen ; Splenic Rupture ; Splenic Vein ; Thrombosis

We developed a novel approach to perform a perfect 11p lymph node dissection (LND), the so-called 'midpancreas mobilization' (MPM) method. Briefly, in pure single-incision laparoscopic distal gastrectomy (SIDG), after the completion of 7, 8a/12a, and 9 LND in the suprapancreatic portion, we started 11p LND after midpancreas mobilization. After mobilization of the entire midpancreas from the white line of Toldt, two gauzes were inserted behind the pancreas. This maneuver facilitated exposure of the splenic vein and complete detachment of soft tissue, including 11p lymph nodes, from the white line of Toldt, which was possible because of the tilting of the pancreas. The dissection plane along the splenic artery and vein for 11p LND could be visualized just through control of the operator's grasper without the need of an assistant. Fourteen patients underwent the procedure without intraoperative events, conversion to conventional laparoscopy, or surgery-related complications, including postoperative pancreatic fistula. All patients underwent D2 LND by exposure of the splenic vein. The mean numbers of retrieved lymph node and 11p lymph node were 61.3 +/- 9.0 (range, 49-70), and 4.00 +/- 3.38 (range, 1-10). Thus, we concluded that MPM for 11p LND in pure SIDG appears feasible and embryologically ideal; this method can be used in conventional laparoscopic gastrectomy.
Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes ; Pancreas ; Pancreatic Fistula ; Splenic Artery ; Splenic Vein ; Stomach Neoplasms* ; 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

PURPOSE: Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery. METHODS: We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups. RESULTS: APSVT was diagnosed a mean of 8.6 +/- 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296). CONCLUSION: Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.
Anticoagulants ; Case-Control Studies ; Follow-Up Studies* ; Hemorrhage ; Humans ; Mesentery ; Multivariate Analysis ; Portal Vein ; Retrospective Studies ; Splenic Vein* ; Thrombosis* ; Veins

PURPOSE: It is believed that blood from the superior mesenteric vein and splenic vein mixes incompletely in the portal vein and maintains a streamline flow influencing its anatomic distribution. Although several experimental studies have demonstrated the existence of streamlining, clinical studies have shown conflicting results. We investigated whether streamlining of portal vein affects the lobar distribution of colorectal liver metastases and estimated its impact on survival. METHODS: Data of patients who underwent hepatectomy for colorectal liver metastases were retrospectively collected. The chi-square test was used for analyzing the distribution of metastasis. Cox analysis was used to identify risk factors of survival. Fisher exact test was used for subgroup analysis comparing hepatic recurrence. RESULTS: A total of 410 patients were included. The right-to-left ratio of liver metastases were 2.20:1 in right-sided colon cancer and 1.39:1 in left-sided cancer (P = 0.017). Cox analyses showed that margin < 5 mm (P < 0.001; 95% confidence interval [CI], 1.648–4.884; hazard ratio [HR], 2.837), age ≥ 60 years (P = 0.004; 95% CI, 1.269–3.641; HR, 2.149), N2 status (P < 0.001, 95% CI, 1.598–4.215; HR, 2.595), tumor size ≥ 45 mm (P = 0.014; 95% CI, 1.159–3.758; HR, 2.087) and other metastasis (P = 0.012; 95% CI, 1.250–5.927; HR, 2.722) were risk factors of survival. However, in 70 patients who underwent right hemihepatectomy for solitary metastasis, left-sided colorectal cancer was a risk factor (P = 0.019; 95% CI, 1.293–17.956; HR, 4.818), and was associated with higher recurrence than right-sided cancer (43.1% and 15.8%, respectively, P = 0.049). CONCLUSION: This study showed significant difference in lobar distribution of liver metastases between right colon cancer and left colorecral cancer. Furthermore, survival of left-sided colorectal cancer was poorer than that of right-sided cancer in patients who underwent right hemihepatectomy for solitary metastasis. These findings can be helpful for clinicians planning treatment strategy.
Colonic Neoplasms ; Colorectal Neoplasms ; Hepatectomy ; Humans ; Liver* ; Mesenteric Veins ; Neoplasm Metastasis* ; Portal Vein* ; Recurrence ; Retrospective Studies ; Risk Factors ; Splenic Vein

Pancreatic pseudocyst rupture into the portal vein is a very rare complication and only three reported cases were confirmed using MRI. We report the case of a 50-year-old man with fistula formation between the pseudocyst and the portal vein, confirmed noninvasively by MRI. T2-weighted MR images and magnetic resonance cholangiopancreatography showed fluid signal intensity within the portal, superior mesenteric, and splenic veins, and a direct communication between the pseudocyst and the portal vein.
Cholangiopancreatography, Magnetic Resonance ; Fistula* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreatic Pseudocyst* ; Pancreatitis ; Portal Vein* ; Rupture ; Splenic Vein ; Venous Thrombosis

Portal vein thrombosis (PVT) is a clinical situation that usually begins at the extrahepatic portal vein and sometimes extends into the intrahepatic portal vein, or distally to the superior mesenteric and splenic veins. The clinical presentation (asymptomatic to fatal bowel ischemia) and etiology (liver cirrhosis, systemic cause such as hypercoagulable state and myeloproliferative diseases, local cause such as acute appendicitis) is so diverse that the clinical decision making is sometimes very difficult. When the thrombus extends into the superior mesenteric vein, bowel ischemia and infarction should be anticipated and prevented cautiously with immediate initiation of anticoagulant therapy. The most troublesome chronic sequelae of the portal vein thrombosis is portal vein hypertension, which deteriorates patients' quality of life. The goal of treatment is to prevent ischemic bowel infarction and portal vein hypertension. Color Doppler sonography, computed tomography, and magnetic resonance imaging are convenient diagnostic tools to confirm PVT. The systemic thrombotic state or cause of infection must be determined through serologic studies. It is helpful to divide PVT patients into cirrhotic and non-cirrhotic, acute and chronic patients. In cases of non-cirrhotic acute PVT, rapid correction of the systemic and local cause of thrombosis and early initiation of anticoagulant therapy are considered the gold standard of treatment. In cases of cirrhotic and chronic PVT, the risk of bleeding and the efficiency of anticoagulation therapy should be measured and balanced for each patient. This article discusses the debated issue of the various treatment paradigms for PVT.
Decision Making ; Fibrosis ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Ischemia ; Magnetic Resonance Imaging ; Mesenteric Veins ; Portal Vein ; Quality of Life ; Splenic Vein ; Thrombosis