1/49. Pitfalls of transhepatic portal venography and therapeutic coronary vein occlusion.Coronary vein occlusions via transhepatic portography for bleeding esophageal varices was attempted in 24 patients. Problems occurred that either prevented the attempt or resulted in less than adequate occlusion. These included blood flow in the left gastric (coronary) vein toward the liver due to occluded or stenotic splenorenal shunts, spontaneous left gastric vein to inferior vena cava shunts, and failure of powdered Gelfoam and heat-treated autogenous clot to cause permanent occlusion. Of 89 total transhepatic portographies, 65 for diagnosis and 24 for occlusion, major complications occurred in two.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
2/49. Balloon-occluded retrograde transvenous obliteration of gastric varix draining via the left inferior phrenic vein into the left hepatic vein.We encountered a patient with gastric varix draining not via the usual left suprarenal vein but via the left inferior phrenic vein joining the left hepatic vein. Transfemoral balloon-occluded retrograde transvenous obliteration (BRTO) of the varix was performed under balloon occlusion of the left inferior phrenic vein via the left hepatic vein and retrograde injection of the sclerosing agent (5% of ethanolamine oleate) into the gastric varix. Disappearance of the gastric varix was confirmed on endoscopic examination 2 months later.- - - - - - - - - - ranking = 0.125keywords = occlusion (Clic here for more details about this article) |
3/49. Gastric varices with splenic vein occlusion treated by splenic arterial embolization.A 53-year-old man was admitted to our hospital in August 1997 with enlarged gastric varices. Computed tomography (CT) showed splenic vein occlusion, gastric varices, and extra-gastric wall collateral veins. color flow images of gastric varices were clearly visualized, and the velocity in the gastric varices was 19.6 cm/s via endoscopic color Doppler ultrasonography (ECDUS). The patient was diagnosed with gastric varices according to angiographic findings of splenic vein occlusion, and splenic arterial embolization was performed. Two weeks after the splenic arterial embolization, CT showed peripheral areas of low attenuation in the spleen, due to splenic infarction, with 70% of the spleen volume showing low attenuation. Eight months after the splenic arterial embolization, ECDUS revealed a decrease in gastric variceal color flow images, with the velocity in the gastric varices being 10.3 cm/s.- - - - - - - - - - ranking = 0.75keywords = occlusion (Clic here for more details about this article) |
4/49. splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum: report of a case.We report a patient with splenic vein occlusion (SVO) secondary to tuberculosis. A 17-year-old male patient with mild epigastric pain and splenomegaly was found to have gastric varices by gastroscopy, and SVO by selective angiography. At operation, the splenic vein was occluded by hard fibrous tissue at the splenic hilum, and thus a splenectomy was performed. A microscopic examination of the tissue revealed caseous necrosis surrounded by epithelioid cells and Langhans-type giant cells. Although there were no other findings suggesting intestinal tuberculosis, it seemed that tuberculous lymphadenitis of the splenic hilum most likely caused the occlusion of the splenic vein. Because specific tests for tuberculosis were negative in both immunohistochemical staining for bacille Calmette-Guerin and polymerase chain reaction of dna for mycobacterium tuberculosis, the time of infection was assumed to have occurred a long time before. SVO can sometimes be seen in pancreatic diseases, but this patient with tuberculosis appears to be the first such reported case in the English literature.- - - - - - - - - - ranking = 0.75keywords = occlusion (Clic here for more details about this article) |
5/49. Stent recanalization of chronic portal vein occlusion in a child.An 8-year-old boy with a 21/2 year history of portal hypertension and repeated bleedings from esophageal varices, was referred for treatment. The 3.5-cm-long occlusion of the portal vein was passed and the channel created was stabilized with a balloon-expandable stent; a portosystemic stent-shunt was also created. The portosystemic shunt closed spontaneously within 1 month, while the recanalized segment of the portal vein remained open. The pressure gradient between the intrahepatic and extrahepatic portal vein branches dropped from 17 mmHg to 0 mmHg. The pressure in the portal vein dropped from 30 mmHg to 17 mmHg and the bleedings stopped. The next dilation of the stent was performed 12 months later due to an increased pressure gradient; the gastroesophageal varices disappeared completely. Further dilation of the stent was planned after 2, 4, and 6 years.- - - - - - - - - - ranking = 0.625keywords = occlusion (Clic here for more details about this article) |
6/49. Laparoscopic Sugiura procedure for conditioning of the blood stream through TIPSS in cirrhotic patient. Initial experience.The Sugiura procedure or the proximal gastric devascularisation was formerly the method of choice for esophageal varicose treatment in some patients. The frequency of this operation decreased stenting after the introduction of the transjugular portosystemic shunt into clinical practice. However this method performed laparoscopically could be useful as a complementary procedure when the blood stream through the transjugular intrahepatic portosystemic stent shunt is low and an esophageal rebleeding occurs. A 40-year old patient with hepatic cirrhosis and child stage "B" was admitted to our clinic due to recurrent esophageal varicose bleeding. He underwent a transjugular intrahepatic portosystemic stent shunt implantation 27 months before the admission and the transjugular intrahepatic portosystemic stent shunt became occluded 3 times since implantation and was repeatedly revised. After admission a color Doppler of the stent was performed. The blood stream was 15 cm/s. The laparoscopic Sugiura procedure was performed after conditioning of the general status of the patient. Five ports were introduced 5 cm above the umbilicus, under the xiphoid, the right and left hypochondrium as well as the left mesogastrium. The dilated veins between the gastric coronary vein and esophagus and the short gastric veins on the great curvature were interrupted by means of an ultrasonic scalpel. The hiatus esophagus was opened, the esophagus was prepared up to the first pulmonal vein and the dilated esophageal veins were occluded with stitch ligatures. The operation was completed with Toupet partial fundoplication. The patient was followed 6 months after the surgery. No rebleeding occurred in this time period. Immediately after surgery the blood flow increased up to 97 cm/s; at 3 and 6 months follow-up the intrahepatic shunt remained open with 82 and 80 cm/s blood flow respectively. Laparoscopic Sugiura procedure performed as a complementary surgery after transjugular intrahepatic portosystemic stent shunt implantation increased blood perfusion through the intrahepatal constructed shunt and prevented its occlusion. However this initial experience has to be confirmed with a larger number of patients.- - - - - - - - - - ranking = 0.125keywords = occlusion (Clic here for more details about this article) |
7/49. Pancreatic cancer presenting as bleeding gastric varices.Given the extremely poor prognosis of pancreatic adenocarcinoma, early diagnosis is crucial; however, clinical signs and symptoms of the disease are neither sensitive nor specific. In the two cases described, previously undiagnosed pancreatic cancers initially presented with upper gastrointestinal tract hemorrhage. Endoscopic surveys to identify the origin of the bleeding revealed gastric varices secondarily attributed to splenic vein thrombosis. Upon further investigation, the splenic vein occlusions were found to be caused by pancreatic tumors. A review of the incidence, pathogenesis, diagnostic modalities, and implications of splenic vein occlusion is included.- - - - - - - - - - ranking = 0.25keywords = occlusion (Clic here for more details about this article) |
8/49. Endoscopic variceal ligation for intractable esophageal variceal bleeding in children with idiopathic extrahepatic portal vein occlusion: report of three cases.Extrahepatic portal vein occlusion (EPVO) is an important cause of extrahepatic portal hypertension and variceal hemorrhage in children. We report 3 children with a diagnosis of EPVO and intractable esophageal variceal bleeding who underwent scheduled endoscopic variceal ligation (EVL) and prophylactic propranolol therapy for eradication of esophageal varices. Complete variceal obliteration was achieved in all 3 children following 3-4 treatment sessions. There were no significant complications or gastrointestinal hemorrhage during a follow-up period of 9 to 31 months after variceal eradication. In conclusion, EVL and long-term propranolol prophylaxis is safe and effective in eradicating bleeding esophageal varices in children with EPVO.- - - - - - - - - - ranking = 0.625keywords = occlusion (Clic here for more details about this article) |
9/49. Restoration of liver function and portosystemic pressure gradient after TIPSS and late TIPSS occlusion.TIPSS (transjugular intrahepatic portosystemic shunt) may be indicated to control bleeding from esophageal and gastric varicose veins, to reduce ascites, and to treat patients with budd-chiari syndrome and veno-occlusive disease. Numerous measures to improve the safety and methodology of the procedure have helped to increase the technical and clinical success. Follow-up of TIPSS patients has revealed shunt stenosis to occur more often in patients with preserved liver function (child A, child B). In addition, the extent of liver cirrhosis is the main factor that determines prognosis in the long term. Little is known about the effects of TIPSS with respect to portosystemic hemodynamics. This report deals with a cirrhotic patient who stopped drinking 7 months prior to admission. He received TIPSS to control ascites and recurrent esophageal bleeding. Two years later remarkable hypertrophy of the left liver lobe and shunt occlusion was observed. The portosystemic pressure gradient dropped from 24 mmHg before TIPSS to 11 mmHg and remained stable after shunt occlusion. The child's B cirrhosis prior to TIPSS turned into child's A cirrhosis and remained stable during the follow-up period of 32 months. This indicates that liver function of TIPSS patients may recover due to hypertrophy of the remaining non-cirrhotic liver tissue. In addition the hepatic hemodynamics may return to normal. In conclusion, TIPSS cannot cure cirrhosis but its progress may be halted if the cause can be removed. This may result in a normal portosystemic gradient, leading consequently to shunt occlusion.- - - - - - - - - - ranking = 0.875keywords = occlusion (Clic here for more details about this article) |
10/49. Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.- - - - - - - - - - ranking = 0.25keywords = occlusion (Clic here for more details about this article) |
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