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Endoscopic therapy of oesophageal and gastric varices
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
These cases require special consideration because of their near-normal liver function and otherwise excellent long-term prognosis. Patients are often younger and tolerate bleeding better than in the presence of cirrhosis, although gastric variceal and in particular fundal variceal haemorrhage may be more prevalent. Endoscopic techniques and pharmacological therapy are still effective and remain the first line. Although TIPS has been used in these cases it is usually considered a relative contraindication. Surgery is better tolerated in these cases, and in those with isolated splenic vein thrombosis is curative and the treatment of choice. Accurate anatomical assessment of the portomesenteric and splenic venous drainage by angiography is essential.
The rectum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The superior haemorrhoidal veins draining the upper half of the anal canal above the dentate line pass upwards to become the rectal veins; these unite to form the superior rectal vein, which later becomes the inferior mesenteric vein. This forms part of the portal venous system and ultimately drains into the splenic vein. Middle rectal veins exist but are small, unimportant channels unless the normal paths are blocked.
The spleen and lymph nodes
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Splenic vein thrombosis follows acute pancreatitis or may arise in chronic pancreatitis or a pancreatic tumour. Isolated splenic vein thrombosis (without portal vein thrombosis) results in splenomegaly and segmental portal hypertension (predominantly gastric varices – oesophageal varices are present but are less prominent). Portal venous pressure is normal. Varices are often missed on endoscopy.
Predictors of insufficient recanalization and portal hypertensive complications after treatment of non-cirrhotic, non-malignant portal vein thrombosis – a population-based study
Published in Scandinavian Journal of Gastroenterology, 2020
Aurora Lemma, Fredrik Åberg, Heikki Mäkisalo, Pirkka Vikatmaa, Panu Mentula, Ari Leppäniemi, Ville Sallinen
Kaplan–Meier estimates for the development of portal hypertensive complications at 5 years was 43% if ascites was present at baseline and 26% if it was not. In acute thrombosis, Kaplan–Meier estimate for the development of portal hypertensive complications was 22% and 47% in non-acute thrombosis. In a thrombosis extending to the superior mesenteric vein or the splenic vein, Kaplan–Meier estimates for the development of portal hypertensive complications at 5 years were 35% versus 25% in thrombosis only extending to the portal vein. If the patient had a myeloproliferative disease, Kaplan–Meier estimate for the development of portal hypertensive complications was 56% versus 27% if the patient did not have a myeloproliferative disease. If the patient had anemia, Kaplan–Meier estimate for the development of portal hypertensive complications at 5 years was 37% versus 27% if the patient did not have anemia at baseline. If the patient had acute pancreatitis, Kaplan–Meier estimate for the development of portal hypertensive complications at 5 years was 17% versus 33% if the patient did not have acute pancreatitis at baseline (Figure 3(A–C), Supplementary Table 2).
Long-Term Management of Vascular Access Ports in Nonhuman Primates Used in Preclinical Efficacy and Tolerability Studies
Published in Journal of Investigative Surgery, 2020
Lucas A. Mutch, Samuel T. Klinker, Jody J. Janecek, Melanie N. Niewinski, Rachael M. Z. Lee, Melanie L. Graham
The technique for portal VAP (PV) placement has also been previously been described by us [31]. Briefly, after surgical preparation, a small incision (1.5–2 cm) was made approximately 1.5 cm inferior to the left subcostal border, 2 cm from the midline. After entrance of the peritoneum and extrication of the spleen, a branch of the splenic vein was isolated and transected. The catheter was advanced through the transection 5.5 cm to reach the portal vein and was tied into position using the retention beads. The 5.5 cm measure is based on historical necropsy findings that evaluated both the average length from branch point at the splenic hilum to the union of the splenic vein and superior mesenteric vein as well as verification of proper catheter tip location (residing in the portal vein between the splenic vein and hilum of the liver) in transplant eligible animals, i.e. approximately 3–10 kg. After securing the catheter, patency was confirmed by aspirating blood and flushing normal saline. The spleen was then gently returned to abdominal cavity. Using the same incision, blunt dissection was used to create a port pocket over the left lateral rib cage. The catheter was trimmed to appropriate length and attached to the port head which was placed in pocket and the incision was closed in a normal fashion.
Imaging in pancreatitis: current status and recent advances
Published in Expert Opinion on Orphan Drugs, 2018
Itegbemie Obaitan, Umar Hayat, Hiba Hashmi, Guru Trikudanathan
Vascular complications are common in moderate severe and severe AP and include splanchnic vein thrombosis, arterial pseudoaneurysm and hemorrhage secondary to erosion of arteries, veins and capillaries either spontaneously from pancreatic enzymes or following surgical, percutaneous and endoscopic interventions. Splanchnic vein thrombosis may frequently involve the splenic vein followed by portal vein, and superior mesenteric vein either alone or in combination Irrespective of the etiology, splanchnic vein thrombosis is known to occur in up to 24% of patients with acute pancreatitis [18]. Although pathogenesis is unclear, the systemic inflammatory cascade associated with AP together with action of proteolytic enzymes weakens vessel wall and precipitates stasis of blood flow [19,20]. Acute portomesentric venous thrombosis appears as persistent, well-defined intraluminal filling defects with central low attenuation which may be surrounded by well-defined, rim-enhancing venous walls. In case of chronic thrombosis, collaterals can be seen in addition as well. Acute thromboses are accompanied by bowel ischemia which presents as alternating intramural areas of high and low attenuation resulting from submucosal edema or hemorrhage [18]. Small bowel and colonic ischemia with subsequent necrosis and perforation are rare but dreaded complications of severe AP. It is crucial to recognize the CT findings of bowel necrosis including presence of pneumatosis intestinalis, gas in the portomesentric veins and diminished or absent bowel wall enhancement as it carries substantial mortality if not managed expectantly.