RESUMEN
The arterio-portal fistula is a rare entity, generally associated with different causes, among which penetrating trauma stands out. They can occur at the beginning asymptomatic or manifest by a wide spectrum of signs and symptoms with severe limitation of the patient's quality of life and even compromise it. Immediate therapeutic action, whether surgical or endovascular, is vital for the definitive solution of the primary triggering cause. We present the case of a patient with a stab wound to the abdomen who developed an arterioportal fistula with associated portal hypertension as a complication. It is treated by placing a covered stent at the level of the anomalous communication, with definitive clinical and imaging resolution (AU)
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Humanos , Masculino , Adulto , Fístula Arteriovenosa/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Vena Porta/lesiones , Stents , Angiografía por Tomografía Computarizada , Ecocardiografía Doppler en ColorRESUMEN
PURPOSE: Repair of portal vein injury in a hostile abdomen can be very challenging, complicated by massive hemorrhage or stenosis. It can seldom be successfully carried out, even by experienced hepatobiliary surgeons. The ideal venous clamping technique is often not feasible and increases the risk of lethal portal vein laceration. The common mistake being the forceful use of clamps around the vein in the attempt to obtain vascular control, resulting in additional injuries. METHODS: We provide a descriptive report of two cases detailing a careful step-by-step technique for the management of portal vein injury by inserting an endovascular balloon inflated with serum to control bleeding and repair the vein. RESULTS: In patients who required this technique, no bleeding recurrence, nor portal vein thrombosis or stenosis was detected by CT-scan during follow-up. CONCLUSION: The endovascular balloon occlusion technique for the reconstruction of portal vein injuries in hostile abdomen is a safe and life-saving procedure that should be part of the armamentarium of visceral surgeons.
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Oclusión con Balón , Procedimientos Endovasculares , Vena Porta/lesiones , Lesiones del Sistema Vascular/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiologíaAsunto(s)
Endoscopía , Cuerpos Extraños/cirugía , Vena Porta/lesiones , Trombosis/etiología , Animales , Huesos , Angiografía por Tomografía Computarizada , Duodeno/diagnóstico por imagen , Duodeno/lesiones , Femenino , Peces , Cuerpos Extraños/diagnóstico por imagen , Humanos , Perforación Intestinal/complicaciones , Perforación Intestinal/diagnóstico por imagen , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/cirugía , Trombosis/diagnóstico por imagenRESUMEN
OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.
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Venas Hepáticas/lesiones , Vena Porta/lesiones , Lesiones del Sistema Vascular/epidemiología , Adolescente , Adulto , Niño , Bases de Datos Factuales , Femenino , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/cirugía , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/cirugía , Adulto JovenRESUMEN
INTRODUCTION: Portal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. METHODS: We reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. RESULTS: Twenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. CONCLUSION: Despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.
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Traumatismos Abdominales/complicaciones , Venas Mesentéricas/lesiones , Vena Porta/lesiones , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular , Heridas Penetrantes/complicaciones , Adulto , Exsanguinación/etiología , Exsanguinación/mortalidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Análisis de Supervivencia , Centros Traumatológicos/estadística & datos numéricos , Estados Unidos/epidemiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/cirugíaAsunto(s)
Quistes/terapia , Embolización Terapéutica , Arteria Hepática/lesiones , Hepatopatías/terapia , Vena Porta/lesiones , Escleroterapia/efectos adversos , Lesiones del Sistema Vascular/terapia , Anciano , Quistes/complicaciones , Quistes/diagnóstico por imagen , Femenino , Arteria Hepática/diagnóstico por imagen , Humanos , Hepatopatías/complicaciones , Hepatopatías/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Radiografía Intervencional , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaRESUMEN
BACKGROUND: Portal vein injury is uncommon, and the optimal treatment is controversial. We compared the outcomes of ligation vs repair of portal injury using the National Trauma Data Bank. METHODS: Adult patients who suffered portal injury were identified from the National Trauma Data Bank (2002-2014) by International Classification of Diseases, Ninth Revision diagnosis codes. Patients were stratified by treatment modality into no surgery, ligation, and surgical repair using International Classification of Diseases procedure codes. Outcomes including hospital mortality, bowel resection, and length of stay between ligation and surgical repair were compared by Kruskal-Wallis or Fisher exact test as appropriate. Multivariable analyses were performed with logistic regression. RESULTS: Among 752 patients with portal vein injury, 345 patients (45.9%) underwent no surgery, 103 patients (13.7%) had ligation, and 304 (40.4%) underwent surgical repair. Overall mortality was 49%. Age, sex, Injury Severity Score, Glasgow Coma Scale score, presenting blood pressure, and heart rate were similar between groups that underwent ligation and surgical repair. The hospital mortality (59.2% vs 47.7%; P = .08), bowel resection (1.9% vs 1.0%; P = .55), and length of stay (12.5 vs 15.0 days; P = .08) were also comparable between ligation and repair in univariate analysis. In multivariable analysis, hospital mortality for surgical repair was similar to ligation (risk ratio, 0.69; 95% confidence interval, 0.41-1.16; P = .16). CONCLUSIONS: Portal vein injury is associated with significant mortality and morbidity. Surgical repair showed a trend for lower postoperative mortality than ligation, but this was not statistically significant on multivariate analysis. Repair of a traumatic portal vein injury should be attempted, but ligation is an acceptable alternative without an increase in bowel resection rates or a statistically significant increase in mortality.
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Vena Porta/cirugía , Procedimientos Quirúrgicos Vasculares/mortalidad , Lesiones del Sistema Vascular/cirugía , Adulto , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/lesiones , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidad , Adulto JovenRESUMEN
A portal vein aneurysm is the dilatation of the portal vein due to a defect in the vein wall. This rare disease manifestation is difficult to predict and has the potential for severe complications. We describe the case of a 68-year-old man involved in a motor vehicle collision who presented with abdominal hemorrhage found on ultrasound, hypotension, and vague abdominal pain. The patient underwent an exploratory laparotomy to control bleeding. Surgery and a subsequent abdominal computed tomography revealed the presence of a portal vein pseudoaneurysm and shock bowel. This case highlights the importance of radiologists to consider the prospect of portal vein aneurysm in the differential diagnosis of hypotension following abdominal trauma.
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Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/cirugía , Hígado/lesiones , Hígado/cirugía , Vena Porta/lesiones , Choque Hemorrágico/diagnóstico por imagen , Choque Hemorrágico/cirugía , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Accidentes de Tránsito , Anciano , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
INTRODUCTION: Vasculobiliary and vascular injuries following cholecystectomy are the most serious complications requiring complex surgical management resulting in greater patient morbidity and mortality. METHODOLOGY: The study was performed at a tertiary teaching hospital of North India. Records of patients referred for biliary or vascular injury sustained during cholecystectomy were reviewed retrospectively to identify patients with vascular injury between January 2009 and March 2018. Clinical profile, hospital course and outcome of these patients were analysed. RESULTS: Over nine years, 117 patients were referred for cholecystectomy related complications. Total incidence of vascular injury was 5.1% (6/117). Combined vasculobiliary injury (VBI) occurred in 3.4% (4/117) while isolated vascular injury was present in 1.7% patients (2/117). Most (5/6) patients were operated for uncomplicated gall stone disease. Incidences of portal vein (PV) and right hepatic artery (RHA) injuries were equal (3/6). PV injuries were repaired either during cholecystectomy (1/3) or during re-exploration after damage control packing (2/3). RHA injuries presented as pseudoaneurysm and were managed surgically (2/3) or by coil embolization (1/3). All VBI referrals (4/117) were following open cholecystectomy. In VBI patients, vascular injury was diagnosed intra-operatively in two while it was diagnosed several weeks after cholecystectomy in two others. Biliary injury manifested as bile leak post-operatively in all four of them. Nature of biliary injury could be characterized in only 50% (2/4) patients. Definitive repair of biliary injury was performed in one patient only. There was one mortality in our series. CONCLUSION: Vascular injury is an uncommon complication of cholecystectomy with catastrophic outcome if not managed timely and properly. Adequate surgeon training, keeping the possibility of aberrant vasculobiliary anatomy in all cases, and proper surgical technique is crucial for prevention of such injuries. However in such an event, proper documentation and referral to tertiary centre will help in decreasing morbidity and further litigation.
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Colecistectomía/efectos adversos , Arteria Hepática/lesiones , Complicaciones Intraoperatorias/cirugía , Vena Porta/lesiones , Complicaciones Posoperatorias/cirugía , Lesiones del Sistema Vascular/cirugía , Adulto , Femenino , Cálculos Biliares/cirugía , Humanos , Incidencia , India , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/epidemiología , Adulto JovenAsunto(s)
Cateterismo Periférico/instrumentación , Embolización Terapéutica/métodos , Esponja de Gelatina Absorbible/uso terapéutico , Hemorragia/etiología , Hemorragia/prevención & control , Vena Porta/lesiones , Punciones/efectos adversos , Vena Esplénica/lesiones , Técnicas de Cierre de Heridas , Cateterismo Periférico/métodos , Hemorragia/diagnóstico por imagen , Humanos , Vena Porta/diagnóstico por imagen , Vena Esplénica/diagnóstico por imagen , Resultado del TratamientoRESUMEN
A 26-year-old man presented with gunshot wound to the epigastrium. At surgery, he was hemodynamically stable and had a tense hematoma with thrill in zone 2 (right side) and porta triad. After liver injury was controlled, he underwent percutaneous stenting of a renal artery-vena cava fistula and the hepatic artery injury was followed. Historically, penetrating injury to zone 2 has mandated operative exploration. However, with the advent of endovascular options, in stable patients, catheter-based options offer a reasonable alternative with less risk of blood loss and possible nephrectomy. Renal artery stenting has been advocated for renal artery cava fistulas. The role of timing, hybrid operating suites, and traditional operative exposure will vary based on presentation and institutional capabilities.
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Traumatismos Abdominales/cirugía , Procedimientos Endovasculares/métodos , Hematoma/cirugía , Hígado/cirugía , Arteria Renal/cirugía , Fístula Vascular/cirugía , Vena Cava Inferior/cirugía , Heridas por Arma de Fuego/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Adulto , Contusiones , Hematoma/diagnóstico por imagen , Hematoma/etiología , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/lesiones , Humanos , Hígado/diagnóstico por imagen , Hígado/lesiones , Vértebras Lumbares/lesiones , Masculino , Páncreas/lesiones , Vena Porta/diagnóstico por imagen , Vena Porta/lesiones , Arteria Renal/diagnóstico por imagen , Arteria Renal/lesiones , Venas Renales/diagnóstico por imagen , Venas Renales/lesiones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/etiología , Stents , Tomografía Computarizada por Rayos X , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/lesiones , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagenRESUMEN
No disponible
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Humanos , Masculino , Adolescente , Infarto/diagnóstico por imagen , Vena Porta/lesiones , Esplenectomía , Enfermedad Veno-Oclusiva Hepática/diagnóstico por imagen , Complicaciones PosoperatoriasRESUMEN
An injury of major vessels is a life - threating complication in laparoscopic urology. Review of the literature and analysis of own cases have been performed. The authors offer original surgical management with using hand-assistant technic. It has advantages of open and laparoscopic approach.
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Arteria Femoral/lesiones , Complicaciones Intraoperatorias/etiología , Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Vena Porta/lesiones , Procedimientos Quirúrgicos Urológicos/efectos adversos , Adulto , Pérdida de Sangre Quirúrgica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: The purpose of this study was to assess the incidence of major hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS) insertion using a stent graft at the main portal vein bifurcation. PATIENTS AND METHODS: TIPS insertion using stent grafts was performed in 215 patients due to non-variceal hemorrhage indications. There were 137 men and 78 women, with a mean age of 57 years±10.6 (SD) (range: 19-90 years). Based on retrospective review of portal venograms, TIPS inserted within 5mm from the portal vein bifurcation were considered "bifurcation TIPS", while those inserted 2cm or greater from the bifurcation were considered intrahepatic. Suspicion for acute major periprocedural hemorrhage were categorized as low, moderate, and high, based on the number of signs of hemorrhage. RESULTS: Of 215 TIPS inserted for purposes other than hemorrhage, the TIPS was inserted at the portal bifurcation in 41 patients (29 men, 12 women; mean age, 55.9±11.7 (SD); range: 26-79 years) and intrahepatic in 62 patients (37 men, 25 women; mean age, 57.6±10.6 (SD), range: 34-82 years), whereas 112 were indeterminate in location. No active extravasations were identified on post-TIPS portal venograms. Suspicion for acute major hemorrhage was moderate or high in 3/41 (7%) of patients in the TIPS bifurcation group compared to 5/62 (8%) in the intrahepatic TIPS group (P>0.99). There were no significant differences in 30-day mortality rates (1/41 [2%] and 3/62 [5%] respectively; P> 0.99). No deaths or interventions were attributed to acute hemorrhage. CONCLUSION: TIPS insertion at the portal bifurcation with stent grafts did not incur an elevated risk of hemorrhagic complications.
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Hemorragia/epidemiología , Hemorragia/etiología , Vena Porta/lesiones , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Stents , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Adulto JovenRESUMEN
An 11-year-old Thoroughbred mare with colic unresponsive to medical treatment underwent exploratory laparotomy. During surgery the cecum was found entrapped within the epiploic foramen from left to right. The entrapped cecum was reduced through the foramen by gentle traction. After reduction of the cecum, rupture of the portal vein was detected. Loss of a large amount of blood prompted euthanasia during surgery.
Encapsulation du cæcum dans le foramen omental chez une jument. Une jument Thoroughbred âgée de 11 ans atteinte de coliques ne répondant pas au traitement médical a subi une laparatomie exploratoire. Durant la chirurgie, le cæcum a été trouvé encapsulé dans le foramen omental de gauche à droite. Le cæcum encapsulé a été réduit par le foramen à l'aide d'une légère traction. Après la réduction du cæcum, la rupture de la veine porte a été détectée. La perte d'une grande quantité de sang a entraîné l'euthanasie durant la chirurgie.(Traduit par Isabelle Vallières).
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Cólico/veterinaria , Enfermedades de los Caballos/diagnóstico , Laparotomía/veterinaria , Animales , Ciego/patología , Ciego/cirugía , Cólico/diagnóstico , Cólico/cirugía , Resultado Fatal , Femenino , Enfermedades de los Caballos/cirugía , Caballos , Vena Porta/lesionesRESUMEN
PURPOSE: Transjugular intrahepatic portosystemic shunt (TIPS) creation is used to treat portal hypertension complications. Often the most challenging and time-consuming step in the procedure is the portal vein (PV) puncture. TIPS procedures are associated with prolonged fluoroscopy time and high patient radiation exposures. We measured the impact of transabdominal ultrasound guidance for PV puncture on duration of fluoroscopy time and dose. METHODS: We retrospectively analyzed the radiation dose for all TIPS performed over a four-year period with transabdominal ultrasound guidance for PV puncture (n=212, with 210 performed successfully and data available for 206); fluoroscopy time, dose area product (DAP) and skin dose were recorded. RESULTS: Mean fluoroscopy time was 12 min 9 s (SD, ±14 min 38 s), mean DAP was 40.3±73.1 Gy·cm2, and mean skin dose was 404.3±464.8 mGy. CONCLUSION: Our results demonstrate that ultrasound-guided PV puncture results in low fluoroscopy times and radiation doses, which are markedly lower than the only published dose reference levels.