A Case of Congenital Portal Vein Aneurysm-Few and Far between
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IMAGES IN SURGERY
A Case of Congenital Portal Vein Aneurysm-Few and Far between Rajiv Maharaj 1
&
Balbir Singh 1 & C. Sridhar 2 & K. Venugopal 1
Received: 29 May 2019 / Accepted: 3 January 2020 # Association of Surgeons of India 2020
Abstract Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956, and since then, less than 200 cases have been reported. So, we would like to present our case, a 27-year-old male who presented with left lumbar pain diagnosed with left lower ureteric calculus and had an incidental finding of portal vein aneurysm. It required no treatment, and he was followed up with serial abdominal ultrasound every 6 months, and the patient is doing well without any complications. Hence, conservative management is the best option in the majority of patients. Surgical indication is currently reserved in 10% of cases, which are complicated by rupture, increase in size on surveillance scan, or are otherwise symptomatic; however, post-operative mortality remains extremely elevated. Keywords Portal vein aneurysm . Duodenal compression . IVC compression . Biliary tract obstruction . Portal hypertension
Abbreviations PVA Portal vein aneurysm MPV Main portal vein RPV Right portal vein PHT Portal hypertension
Introduction PVA is defined as a portal vein diameter exceeding 1.9 cm in cirrhotic patients and 1.5 cm in normal livers. It can be congenital or acquired, and portal hypertension represents the main cause of the acquired version [1]. We here report a case of PVA, an incidental finding in a case of left ureteric calculus and was managed conservatively with surveillance USG abdomen every 6 months.
Case Report A 27-years-old gentleman came with complaints of abdominal pain since 2 days, more in left lumbar region, colicky, radiating to groin, associated with multiple episodes of vomiting—nonbilious. USG abdomen revealed well-defined hypoechoic area in segments 5 and 8 of the liver measuring 7.9 × 7.5 cm with internal vascularity. Five-millimeter calculus in left lower ureter with hydroureteronephrosis (Fig. 1). CECT showed large portal vein aneurysm from distal main portal vein (MPV) and right portal vein (RPV) measuring 8.1 × 7.8 × 6.1 cm. Neck appears wide, measuring 31 mm. No thrombus is seen within the aneurysm (Fig. 2) with left hydroureteronephrosis. He was managed conservatively with review ultrasound showing passed out calculus. He is followed up with surveillance ultrasound for the aneurysm every 6 months with no increase in size of the aneurysm, without any complications.
* Rajiv Maharaj [email protected]
K. Venugopal [email protected]
Balbir Singh [email protected]
1
Department of Surgical gastroenterology and Liver Transplant, Global Hospital, Hyderabad, Telangana, India
C. Sridhar [email protected]
2
Department of Radiology, Global Hospital, lakdikapul, Hyderabad, Telangana 500004, India
Indian J Surg
Fig. 1 USG abdomen revealed well-defined hypoechoic area in segments 5 and
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