Cases reported "Hypersplenism"

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1/13. 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 = 1
keywords = vein
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2/13. portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy.

    A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.
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ranking = 140.08856174458
keywords = thrombosis, vein thrombosis, vein
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3/13. Congenital absence of the portal vein with splenomegaly and hypersplenism in a young woman.

    Congenital absence of portal vein (CAPV) with a systemic shunt of enteric blood is a rare malformation. Twenty-seven cases have been reported to date; with the exception of 4 patients all cases had either liver anomalies or cardiac anomalies. CAPV is usually diagnosed before the age of 18 (25/27 cases). Here we present the case of a 33-year-old woman with CAPV without further anomalies. Beside suffering from circumscript scleroderma, splenomegaly and hypersplenism, the patient was otherwise healthy. diagnosis was based on histological findings, angiography and CT scan. The liver biopsy showed portal tracts with inconspicuous arteries and bile ducts, but with severe loss of portal vein branches and minimal proliferation of bile ductules. In addition, the perivenular sinusoids were slightly dilated with focal parenchymal atrophy. Angiography showed a missing portal vein system and a missing splenic vein with drainage of the enteric blood through dilated perisplenic and perigastric collaterals to the azygos vein system. A CT scan revealed an empty liver hilus without portal vein. Here we discuss clinical aspects of this patient, show radiologic and histopathologic findings, and compare them to other cases in the literature.
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ranking = 10
keywords = vein
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4/13. 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.
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ranking = 189.45141565944
keywords = thrombosis, vein thrombosis, vein
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5/13. A new procedure for management of extrahepatic portal obstruction. Proximal splenic-left intrahepatic portal shunt.

    For management of obstruction of the extrahepatic portal trunk in patients with healthy livers, we designed an end-to-side anastomosis between the proximal splenic vein and the umbilical portion of the left intrahepatic portal vein and performed a splenectomy to relieve portal hypertension, treat hypersplenism, and restore hepatic portal flow. To our knowledge, no other procedure more adeptly restores original hepatic blood flow. Creation of an anastomosis between the coronary vein and umbilical portion of the left intrahepatic portal vein is an alternative method.
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ranking = 4
keywords = vein
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6/13. Accessory splenectomy with gastroesophageal devascularization for recurrent hypersplenism and refractory bleeding varices in a patient with liver cirrhosis: report of a case.

    We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 x 6 x 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.
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ranking = 12.005738932775
keywords = thrombosis
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7/13. Effectiveness of Rex shunt in the treatment of portal hypertension.

    BACKGROUND: Children with portal venous thrombosis often have severe symptoms secondary to portal hypertension including recurrent upper gastrointestinal (UGI) bleeds and hypersplenism. We report results of the use of the mesenterico-left portal bypass (Rex shunt) in 5 consecutive patients. methods: A retrospective chart review of all patients with portal venous thrombosis who underwent Rex shunt procedure was performed. Children were evaluated preoperatively with magnetic resonance angiogram, Doppler ultrasound, and mesenteric angiogram. Postoperative ultrasounds were performed in follow-up. RESULTS: All patients had evidence of portal hypertension and hypersplenism. The average age of the patients was 13.2 /- 4.9 (7-19) years. The patient had an average of 2.6 /- 1.7 UGI bleeds requiring banding and 3.4 /- 4.2 U of blood transfused before undergoing the shunt. The mean operative time was 383 /- 46 minutes, and length of stay was 10.4 /- 7.1 days. In follow-up of 18.8 /- 5.2 months (11-24 months), all but 1 patient had a patent shunt. One narrowed shunt was successfully dilated by percutaneous angioplasty. thrombocytopenia improved significantly in patients with functioning shunts but did not correlate with a significant decrease in splenic size. CONCLUSIONS: The Rex shunt reestablishes normal hepatopedal portal flow, and in patients with functioning shunts, no recurrent UGI bleeds or transfusions were required or evidence of encephalopathy were noted.
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ranking = 24.011477865551
keywords = thrombosis
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8/13. Cavernous transformation of the portal vein complicating pregnancy.

    BACKGROUND: Cavernous transformation of the portal vein, associated with varices and thrombocytopenia, rarely complicates pregnancy. CASE: A 20-year-old primigravida with cavernous transformation of the portal vein underwent wireless video esophageal capsule endoscopy at 28 weeks of gestation, which ruled out esophageal and gastric varices and the need for prophylactic sclerotherapy. magnetic resonance angiography at 32 weeks of gestation showed no abdominal wall varices or abnormally dilated lumbar or extradural veins, which ensured a safe surgical approach for cesarean and preserved the patient's ability to receive regional anesthesia. CONCLUSION: New noninvasive imaging modalities aided evaluation and management of the gravida with cavernous transformation of the portal vein.
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ranking = 8
keywords = vein
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9/13. Ultrasound diagnosis of portal vein thrombosis following splenectomy.

    We present a case of clinically unsuspected portal vein thrombosis occurring soon after splenectomy in a patient with chronic lymphocytic leukaemia. Ultrasound provided a means of easy and accurate diagnosis and allowed frequent reassessment of the thrombus during the period of its resolution under conservative management.
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ranking = 115.90713478715
keywords = thrombosis, vein thrombosis, vein
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10/13. Computed tomography follow-up of nonsurgical treatment for hypersplenism.

    For the treatment of hypersplenism, transcatheter embolization of the splenic artery and collateral vessels is an alternative to splenectomy, notably in high-risk or immunosuppressed patients. After arterial occlusion and thrombosis, follow-up computed tomography scans depict progressive changes in the extent and appearance of splenic infarcts, such that these changes correlate with improved platelet counts. Computed tomography thus performs the unique role of identifying specific patterns of infarction and also differentiating internal defects, such as suppurative, gaseous, or liquefaction necrosis.
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ranking = 12.005738932775
keywords = thrombosis
(Clic here for more details about this article)
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