Umbilical vein recanalization with one stage stent placement as modified Meso-rex bypass for portal vein cavernous transformation / 中国实用外科杂志

OBJECTIVE:To study the effect of modified meso-rex surgery combined with umbilical vein recanalization and primary stent implantation in the treatment of portal vein portal vein cavernous transformation.METHODS:A retrospective study was conducted in Beijing Tsinghua Changgung Hospital. A patient underwent classic or thotopic total liver transplantation for more than 9 years, admitted in February 2018 was selected.Her main portal vein occlusion and portal vein cavernous transformation were followed by portal hypertension, esophageal and gastric varices, and gastrointestinal bleeding. Surgical treatment of Meso-rex bypass were performed. During operation, hyperplasia of the left liver was noted. After wedge resection of part of the left liver parenchyma, the stump of ligamentum teres hepatis was exposed. Left portal vein was difficult to be dissected and exposed. After the umbilical vein was recanalized to the left branch of the portal vein, vascular anastomosis and stent implantation were completed. Postoperative anticoagulant therapy was given,and the blood flow was monitored.RESULTS:The shunt procedure was successful. The bypass patent, and blood flow was unobstructed 1-year post-operation. No gastrointestinal bleeding occurred ever.CONCLUSION:Meso-rex bypass combined with umbilical vein recanalization and primary stent implantation can be used to treat patients with portal vein cavernous transformation whose left portal vein is patent but difficult to be exposed.The long-term effect is worth expecting and more cases are needed for further verification.

Colangiopatía portal: complicación poco frecuente de la hipertensión portal / Portal cholangiopathy: infrequent portal hypertension complication / Colangiopatia do portal: complicação incomum da hipertensão portal

Se describe el caso clínico de una mujer de 62 años en la que se diagnostica una estenosis del colédoco en el contexto de hipertensión portal prehepática (cavernomatosis portal).

We report the case of a 62 years old woman with a choledochal stricture and chronic obstruction of the portal vein (portal cavernomatosis).

Relatamos o caso de uma mulher de 62 anos com diagnóstico de estenose do colédoco no contexto da hipertensão portal pré-hepática (cavernomatose portal).

Portal cholangiopathy: case report / Colangiopatia portal: relato de caso

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Relata-se o caso de uma criança que após trauma abdominal fechado apresentou trombose portal, seguida por esplenomegalia progressiva e icterícia. Os achados da ultrassonografia e da colangiografia percutânea mostraram dilatação de vias biliares secundária à constrição do colédoco por veias pericoledocianas dilatadas, configurando caso de colangiopatia portal. O objetivo deste relato é a apresentação de causa incomum desta condição.

Exploration of treatment for common bile duct stones combined with cavernous transformation of the portal vein / 中华肝胆外科杂志

Objective To explore more safe and effective method for the treatment of common bile duct stones combined with cavernous transformation of the portal vein (CTPV).Methods We report 2 cases of post-treated patients in this series.In order to avoid severe bleeding caused by dissection of bile duct,we applied different methods to remove common bile duct stones compared with traditional operation.We removed common bile duct stones in one patient through cystic duct approach during operation.Two years later,we performed endoscopic duodenal incision (endoscopic sphincterotomy,EST) for him because of lower common bile duct stenosis with sand like stone.Another patient,on the other hand,we conducted the duodenal papilla incision during operation and removed common bile duct stones with choledochoscope through the bottom of common bile duct.Result Of the two patients,all of the three kinds of operation had good curative effects.Conclusions For the patients with common bile duct stones combined with CTPV,we should select appropriate treatments to avoid dissection of bile duct in front of the dilated and tortuous collateral veins during the operation,which is the key to guarantee the safety and success of the operation.EST is the preferred method of the treatment.Open operation with choledochoscopy via cystic duct approach or duodenal papilla incision through distal common bile duct to perform stone extraction also appears to be effective and safe.

Color Doppler flow imaging and contrast-enhanced ultrasound in diagnosis of hepatic vascular anomalies / 第二军医大学学报

Objective: To summarize the major ultrasonic manifestations of various hepatic vascular anomaly(HVA), so as to improve the ultrasonic diagnosis rate of HVA. Methods: The chief complaints, timing and mode of ultrasonic diagnosis of 18 patients with congenital HVA or post-liver transplantation HVA were retrospectively analyzed. Six of the 18 patients were subjected to detailed analysis. The major ultrasonic manifestations of various HVA were observed and experience of ultrasonic diagnosis was summarized. Results: The major vascular abnormalities in our group included hepatic vascular fistula (including fistulas between artery and vein, artery and portal vein, portal vein and hepatic vein, also a complex fistula among artery, portal vein and hepatic vein), portal aneurysm, congenital portal atresia and portal vein cavernous transformation; among which the portal atresia and the complex hepatic fistula involving hepatic artery, hepatic vein and portal vein were rarely described in the literature. Color Doppler ultrasound was the first choice for detection and diagnosis of HVA; contrast-enhanced ultrasound was sensitive and specific in diagnosis of all vascular fistulas due to its ability to display homodynamic phase. Conclusion: The wide application of Doppler and contrast-enhanced ultrasound examination improves the detection and diagnosis of HVA; diagnosis should be made based on scientific diagnosis mode and precise diagnosis planning.