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11/229. Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience.

    A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.
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ranking = 1
keywords = thrombosis
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12/229. rupture of the left kidney following renosplenic shunt.

    kidney rupture following division of the left renal vein during portal decompression is presented. A review of the renal venous anatomy is described and a possible explanation of this ususual occurrence is offered.
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ranking = 0.26682867504639
keywords = vein
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13/229. Massive splenic infarction in cirrhosis: report of a case with spontaneous disappearance of hypersplenism.

    A cirrhotic patient with massive splenic infarction is described. Celiac angiography showed normally opacified splenic artery and vein and a markedly enlarged spleen with large avascular zones. splenic infarction was associated with the spontaneous disappearance of a syndrome of hypersplenism. The spleen was surgically removed. Histological examination showed multiple thromboses of the small arterial and venous vessels. The cause of this infarct remained unclear.
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ranking = 0.26682867504639
keywords = vein
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14/229. Pancreatic adenocarcinoma presenting as sinistral portal hypertension: an unusual presentation of pancreatic cancer.

    A rare syndrome, sinistral (left-sided) portal hypertension resulting from splenic vein thrombosis secondary to pancreatic adenocarcinoma of the tail is presented here. Pancreatic cancer is notorious for presenting with vague and nonspecific symptoms, including but not exclusively weight loss, abdominal pain, and anorexia with or without jaundice. However, physicians should be aware that in the presence of splenic vein thrombosis, this finding alone puts pancreatic cancer high on the differential diagnosis.
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ranking = 3.8503182550233
keywords = thrombosis, vein thrombosis, vein
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15/229. 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.
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ranking = 2.1346294003711
keywords = vein
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16/229. Idiopathic splenic vein stenosis: a cause of gastric variceal hemorrhage.

    We report the case of a patient with isolated gastric variceal bleeding. obesity precluded the use of noninvasive means for assessing splenic vein patency. splenic vein stenosis was diagnosed by transhepatic portal and splenic venography with pressure measurements. A cause for the stenosis could not be found. splenectomy was used as a curative measure.
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ranking = 1.6009720502783
keywords = vein
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17/229. Adherence of cyanoacrylate which leaked from gastric varices to the left renal vein during endoscopic injection sclerotherapy: a histopathologic study.

    We report a case involving leakage of cyanoacrylate (CA) to the inferior vena cava (IVC) through a gastrorenal shunt and left renal vein. A 72-year-old man with liver cirrhosis was admitted to our hospital to undergo emergency treatment for massive hemorrhage of gastric varices. Endoscopic injection sclerotherapy (EIS) using CA was performed on the varices. Radiographic fluoroscopy revealed that most of the injected CA had adhered firmly to the gastric varices, but a certain portion of the CA had flowed to the IVC through the gastrorenal shunt and left renal vein. At that point, the patient did not complain of any symptoms. However, 6 months later, he died of hepatic failure and an autopsy was performed. Histopathologic examination of the wall of the IVC and renal vein, to which CA had adhered, revealed that the CA was covered with endothelial cells of the vessel and no nearby thrombus was present. Long-term anticoagulant therapy may not be indicated in cases of leakage of CA from the gastric varices to other veins, since the leaked CA may be readily covered with endothelium without thrombus formation as in our patient. It is possible for CA to flow to the IVC and have a fatal impact. Our patient was fortunate, and for safe EIS it is important that these complications are prevented.
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ranking = 2.1346294003711
keywords = vein
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18/229. 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.
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ranking = 1.3341433752319
keywords = vein
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19/229. A rare complication of endoscopic injection sclerotherapy: thrombosis of subclavian vein.

    A 28-year-old man with compensated cirrhosis of the liver (child B) and after 4 episodes of esophageal variceal bleeding received prophylactic endoscopic variceal sclerotherapy in our gastroenterology Clinic for 8 consecutive months. sclerotherapy of the esophageal varices had been performed at monthly intervals until variceal obliteration was achieved. Both the intravariceal and paravariceal injection techniques were used and injections were repeated periodically as necessary. On the 8th month, 1 week after the 4th sclerotherapy procedure, the patient complained of swelling on his right shoulder and on his right arm. There was jugular congestion and swelling of his right arm and right shoulder. The patient was hemodynamically stable. An X-ray of brachial venography revealed an obstruction of the vena subclavia dextra. During follow-up, the jugular congestion and swelling of his right arm gradually subsided spontaneously over a 6-month period without any need for medication. There has been no recurrence of his symptoms during the 1-year follow-up period. Now, he is still well clinically. This experience suggests that endoscopic injection sclerotherapy may cause thrombosis of the subclavian vein which have been never seen before.
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ranking = 6.3341433752319
keywords = thrombosis, vein
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20/229. Fatal bleeding from a residual vein at the esophageal ulcer base after successful endoscopic variceal ligation.

    Endoscopic variceal band ligation (EVL) is now one of the accepted treatment options for esophageal varices, and the safety of this procedure has been proved. However, we experienced a patient who had a fatal massive bleeding after successful EVL for ruptured esophageal varix. Postmortem study revealed a residual vein at the base of the esophageal ulceration associated with the ligation, which was believed to be the site of the fatal bleeding. His platelet counts and prothrombin time were not very impaired. Our case indicates that fatal massive bleeding can occur in patients after successful EVL without specific risk factors and indicates the importance of the awareness of the possibility of these complications.
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ranking = 1.3341433752319
keywords = vein
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