Journal of Surgery Concepts & Practice >

2021 , Vol. 26 >Issue 03: 226 - 230

DOI: https://doi.org/10.16139/j.1007-9610.2021.03.010

Original article

Surgical treatment of esophagogastric varices from cavernous transformation of portal vein: one case report

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  • Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medic ine,Shanghai 200127,China

Received date: 2021-04-30

  Online published: 2021-07-27

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Abstract

Objective To discuss the treatment of esophagogastric varices fom cavernous transformation of portal vein(CTPV). Methods A 2l-year-old male patient with CTPV from Department of Gastrointestinal Surgery Renji Hospital im2020 was analyzed retrospectively. Results The patient was admitted with lower WBC count 1.38×109/L and lower plateletcount 37×109/L and abdominal enhanced CT scan showedl main portal vein obliteration and collateral vessels proximal tothe obstruction.The examination revealed negative hepatitis markers and Child-Pugh A stage.He was diagnosed as CTPvassociated with large esophagogastric varices, massive splenomegaly and hypersplenism. He underwent splenectomy,splenorenal shunting and pericardial devascularization and the postoperative recovery was uneventful without hepaticencephalopathy. Postoperative abdominal CTA was suggestive of splenorenal shunt patent. Conclusion lt was suggested that preventive shunting and devascularization were suitable for CTPV associated with large esopha gogastric varices, massive splenomegaly and hypersplenism.

Key words： Cavemous transformation of portal vein; Esophagogastric varices; Portal vein hypertension; Splenorenal shunt

Cite this article

SUN Longci, ZHANG Bin . Surgical treatment of esophagogastric varices from cavernous transformation of portal vein: one case report[J]. Journal of Surgery Concepts & Practice, 2021 , 26(03) : 226 -230 . DOI: 10.16139/j.1007-9610.2021.03.010

References

[1] 闫朝岐, 杨维良. 门静脉海绵样变的临床诊治现状[J]. 中国普通外科杂志, 2008, 17(6):605-607.
[2] Chang CY, Yang PM, Hung SP, et al. Cavernous transformation of the portal vein: etiology determines the outcome[J]. Hepatogastroenterology, 2006, 53(72):892-897.
[3] Spaander MC, Darwish Murad S, van Buuren HR, et al. Endoscopic treatment of esophagogastric variceal blee-ding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study[J]. Gastrointest Endosc, 2008, 67(6):821-827.
[4] 黄飞舟, 刘浔阳. 门静脉高压症出血的内镜治疗[J]. 中华外科杂志, 2008, 46(22):1696-1698.
[5] Li ZP, Wang SS, Wang GC, et al. Transjugular intrahe-patic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(6):517-523.
[6] Niu XK, Das SK, Wu HL, et al. Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma[J]. World J Clin Cases, 2020, 8(5):887-899.
[7] Li LN, Sun XY, Wang GC, et al. Transjugular intrahe-patic portosystemic shunt prevents rebleeding in cirrhotic patients having cavernous transformation of the portal vein without improving their survival[J]. J Dig Dis, 2019, 20(2):89-96.
[8] Lv Y, Qi X, He C, et al. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial[J]. Gut, 2018, 67(12):2156-2168.
[9] Gu S, Chang S, Chu J, et al. Spleno-adrenal shunt: a novel alternative for portosystemic decompression in children with portal vein cavernous transformation[J]. J Pediatr Surg, 2012, 47(12):2189-2193.
[10] Wang RY, Wang JF, Liu Q, et al. Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein[J]. Postgrad Med, 2017, 129(7):768-776.
[11] 花荣, 孙勇伟, 吴志勇. 手术治疗儿童门静脉海绵样变性肝前性门静脉高压症[J]. 肝胆外科杂志, 2005, 13(6):428-430.
[12] 李振东, 张道荣. 小儿门静脉高压症外科治疗二十三年回顾[J]. 中华小儿外科杂志, 1989, 10(2):90.
[13] 杨维良, 闫朝岐, 张好刚. 成人门静脉海绵样变63例的诊断与外科治疗[J]. 中华肝胆外科杂志, 2010, 16(2):115-118.
[14] 郭明晓, 李幼生, 黎介寿. 门静脉海绵样变10例临床分析[J]. 医学研究生学报, 2011, 24(5):513-515.
[15] Wang RY, Wang JF, Sun XG, et al. Evaluation of Rex shunt on cavernous transformation of the portal vein in children[J]. World J Surg, 2017, 41(4):1134-1142.
[16] 张明满, 金先庆, 严律南, 等. 亲体肝移植治疗儿童门静脉海绵样变性3例临床分析[J]. 中华肝脏病杂志, 2008, 16(4):270-273.
[17] Wei B, Zhang L, Tong H, et al. Cavernous transformation of the portal vein in a 26-month old boy treated by transjugular intrahepatic portosystemic shunt: a case report[J]. Front Pediatr, 2019, 7:379.
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