An Unusual Cause of Abdominal Pain
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IMAGES IN SURGERY
An Unusual Cause of Abdominal Pain Zhoupeng Wu 1 & Yukui Ma 1 Received: 12 August 2019 / Accepted: 26 March 2020 # Association of Surgeons of India 2020
Abstract Venous aneurysms, including portal vein aneurysms (PVAs), rarely are encountered in clinical practice. PVAs may be intrahepatic or extrahepatic, and their origin may be congenital or acquired. Acquired lesions are associated with liver disease, trauma, or degenerative changes. Methods of management of PVAs include observation, resection, thrombectomy, or portal venous decompression. This article reports the resection of a large saccular PVA that we speculate was due to degenerative changes. Keywords Portal vein . Aneurysms . Abdominal . Pulmonary embolization
A 48-year-old woman presented to our hospital with abdominal pain, nausea, and vomiting with eating. There was no history of hematemesis, hematochezia, melena, jaundice, abdominal inflammation, and trauma. No abdominal mass was palpated and no vascular bruit was heard. The abdominal ultrasonogram showed a cystic mass that compressed the common bile duct Fig. 1 The abdominal ultrasonogram showed a cystic mass that compressed the common bile duct. Magnetic resonance imaging (MRI) showed a 5-cm diameter mass in the porta hepatis
* Yukui Ma [email protected] 1
Department of vascular surgery, West China Hospital, 37 GuoXue Alley, Chengdu 610041, Sichuan, China
(Fig. 1a). Magnetic resonance imaging (MRI) showed a 5-cm diameter mass in the porta hepatis which suggested it was a portal vein aneurysm (PVA) located near the common duct and hepatic artery (Fig. 1b). After venous control was obtained, the aneurysm was gently compressed and was brought between the common duct and hepatic artery (Fig. 2a).The aneurysm was partly
Indian J Surg Fig. 2 Fig. 2 a The aneurysm was gently compressed and was brought between the common duct and hepatic artery. b Followup MRI scan showed no abnormality of PV in the former region
excised and the portal vein was oversewn, leaving it normal size and contour. The patient has remained well for 1 year. Follow-up MRI scan showed no abnormality of the portal vein in the former region (Fig. 2b). Intrahepatic and extrahepatic PVAs are frequently associated with liver disease which can develop thrombosis and portal hypertension [1]. Large PVAs may compress the portal vein or completely obstruct it when thrombosed. Although thrombosis of a PVA and embolization to the liver has not been reported, it is a potential complication. A PVA may cause deviation and compression of the bile duct, resulting in jaundice, cholestasis, and cholelithiasis, also compress other organs (for example, the duodenum and the inferior vena cava) [2]. Most venous aneurysms are not life-threatening; however, popliteal venous aneurysms are notorious for their propensity to thrombose and cause pulmonary embolization. The rarity of PVA has obscured their natural history, thus making it difficult to predict outcome when they are managed by observation. Surgical intervention in fit patients sh
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