No abstract available.
Arteriovenous Fistula/complications ; Fatty Liver/complications/radiography/ultrasonography ; Hemangioma/etiology/radiography/*ultrasonography ; Hepatic Artery/abnormalities ; Humans ; Liver Neoplasms/radiography/ultrasonography ; Male ; Middle Aged ; Portal Vein/abnormalities ; Tomography, X-Ray Computed

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged ; Arteriovenous Fistula/etiology/radiography/*therapy ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Embolization, Therapeutic/*methods ; Enbucrilate/*therapeutic use ; Esophageal and Gastric Varices/etiology/*therapy ; Hepatic Artery/*abnormalities/radiography ; Humans ; Liver Neoplasms/*surgery ; Male ; Portal Vein/*abnormalities/radiography

OBJECTIVETo investigate the ultrasonographic features of congenital intrahepatic portosystemic venous shunt (CIPSVS) and to assess the clinical value of ultrasonography in the diagnosis of CIPSVS.

METHODSSix cases of CIPSVS diagnosed in our hospital between March 2010 and March 2012 and confirmed by enhanced computed tomography (CT) were retrospectively reviewed. Five of the six cases had follow-up data that was included in the analysis.

RESULTSAmong the six CIPSVS cases, only one was classified as Park's type II and the rest were classified as Park's type III. Five cases involved the right lobe of the liver and only one case involved the left lobe. The lesion shapes included cystic, tubular, and irregular with clear contour and appeared to be anechoic on CT scan. The lesions ranged in size from 1.1*0.6 cm to 2.0*1.7 cm. For all cases, the color Doppler ultrasound images showed blood flowing from the portal vein to the hepatic vein, and single-phase spectrum was detected in the diversion channel. The differences observed in level of lesion size and blood flow velocity at the shunt from the time of examinations at diagnosis and subsequent follow-up did not reach statistical significance (P = 0.223 more than 0.05 and P = 0.930 more than 0.05 respectively).

CONCLUSIONAlthough cases of CIPSVS are rare, they share some specific sonographic features that may help in diagnosis. Color Doppler ultrasound findings have high diagnostic accuracy and may represent a preferred modality for follow-up monitoring.

Aged ; Female ; Humans ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Retrospective Studies ; Ultrasonography ; Vascular Malformations ; diagnostic imaging

A 67-year-old woman presented with memory impairment and behavioral changes. Brain MRI indicated hepatic encephalopathy. Abdominal CT scans revealed an intrahepatic portosystemic venous shunt that consisted of two shunt tracts to the aneurysmal sac that communicated directly with the right hepatic vein. The large tract was successfully occluded by embolization using the newly available AMPLATZERTM Vascular Plug II and the small tract was occluded by using coils. The patient's symptoms disappeared after shunt closure and she remained free of recurrence at the 3-month follow-up evaluation.
Aged ; Embolization, Therapeutic/*instrumentation/methods ; Female ; Hepatic Encephalopathy/etiology/*therapy ; Hepatic Veins/abnormalities/radiography ; Humans ; Liver Circulation ; Portal Vein/abnormalities/radiography ; *Septal Occluder Device

No abstract available.
Hepatic Encephalopathy/*congenital ; Humans ; Liver Neoplasms/*congenital ; Male ; Portal Vein/*abnormalities ; *Septal Occluder Device

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Female ; Humans ; Male ; Mesenteric Veins/radiography ; Pancreas/abnormalities ; Pancreatic Diseases/*diagnosis/therapy ; Pancreatic Fistula/etiology ; Pancreatic Neoplasms/diagnosis/surgery ; Pancreaticoduodenectomy/adverse effects ; Portal Vein/radiography ; Splenic Vein/radiography ; Tomography, X-Ray Computed

A left-sided gallbladder occurring in the absence of situs inversus is a rare anomaly. This anomaly was found in a 50-year-old man without any evidence of pancreatobiliary disease. Epigastric transverse ultrasonography showed a normal gallbladder with its fundus extending past the left lateral end of the liver. Abdominal computed tomography (CT) revealed that the gallbladder was located beneath the quadrate lobe (S4) of the liver to the left of the left branch of the portal vein, and S4 was hypertrophied to compensate for atrophy of the lateral inferior segment (S3) of the liver. Magnetic resonance cholangiopancreatography (MRCP) showed that the gallbladder and pancreatobiliary tree were normal, and that the cystic duct joined the common bile duct from the right side making a characteristic U-shaped hairpin bend.
Atrophy ; Cholangiopancreatography, Magnetic Resonance ; Common Bile Duct ; Congenital Abnormalities ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Humans ; Liver ; Middle Aged ; Portal Vein ; Situs Inversus

A congenital intrahepatic portosystemic shunt is a rare anomaly; but, the number of diagnosed cases has increased with advanced imaging tools. Symptomatic portosystemic shunts, especially those that include hyperammonemia, should be treated; and various endovascular treatment methods other than surgery have been reported. Hepatic masses with either an intra- or extrahepatic shunt also have been reported, and the mass is another reason for treatment. Authors report a case of a congenital intrahepatic portosystemic shunt with a hepatic mass that was successfully treated using a percutaneous endovascular approach with vascular plugs. By the time the first short-term follow-up was conducted, the hepatic mass had disappeared.
Child ; Diagnosis, Differential ; Hepatic Encephalopathy/*congenital/diagnosis/therapy ; Humans ; Liver Neoplasms/*congenital/diagnosis/therapy ; Male ; Portal Vein/*abnormalities ; *Septal Occluder Device ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Ultrasonography, Interventional

Adolescent ; Arteriovenous Malformations ; Female ; Humans ; Portal Vein ; abnormalities

OBJECTIVETo discuss the techniques for excision and reconstruction of anomalous portal venous branches (APVB) in adult-to-adult right lobe living donor liver transplantation (A-A RL LDLT).

METHODSFrom February 2002 to April 2007, 70 cases of A-A RL LDLT were performed. Preoperative three-dimensional computed tomography of the donor revealed the configurations of hepatic artery, portal vein and hepatic vein. Nine donors had anomalous portal venous branching (APVB). The APVB were type II (trifurcation) in 7 cases and type III in two. Except the excision of APVB with a common opening by a narrow bridge of main portal vein tissue in one type II donor, all the right APVB were transected on the principal of donor priority: right APVB being excised approximately 2-3 mm from the confluence while leaving the donor's portal vein intact. In type II APVB, the donor portal venous branches were transected with separate two openings and reconstructed as double anastomoses in 4 cases, with separate two openings joined as a common orifice at the back table and reconstructed as single anastomoses in 2 cases, and with one common opening with narrow-bridge of tissue and reconstructed as single anastomoses in 1 case. In type III APVB, the APVB were transected with separate two openings and were reconstructed by double anastomoses in 1 case and by a new technique named U-shaped vein graft interposition in the another one.

RESULTSThere were no vascular complications such as portal vein stricture or thrombosis, hepatic artery stricture or thrombosis and hepatic vein outflow stricture in all 9 recipients transplanted with grafts with APVB. Only the type II APVB donor undergoing a excision of APVB with a common opening by a narrow bridge of main portal vein tissue developed portal vein thrombosis on the third postoperative day and underwent thrombectomy followed by repair with vein patch plasty. The velocity of blood flow in the U-graft was normal.

CONCLUSIONSIt is feasible and safe of APVB excision on the principal of donor priority and reconstruction including double anastomoses and the novel U-graft interposition in A-A RL LDLT, and has a good outcome without increasing the management difficulty.

Adult ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; methods ; Living Donors ; Male ; Portal Vein ; abnormalities ; surgery ; Retrospective Studies ; Treatment Outcome