Background
Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known.

Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding

Background: Sinistral portal hypertension, a localized (left-sided) form of portal hypertension may complicate chronic pancreatitis as a result of splenic vein thrombosis/obstruction. Aim: To determine appropriate surgical strategy for patients with splenic vein thrombosis/obstruction secondary to chronic pancreatitis. Methods: We reviewed our experience with operative management of 484 consecutive patients with histologically documented chronic pancreatitis treated between 1976 and 1997. The diagnosis of sinistral portal hypertension was based on clinical presentation, preoperative endoscopic and radiographic imaging, and operative findings. “Symptomatic,” herein defined, denotes those patients with sinistral hypertension and either gastrointestinal bleeding or hypersplenism. “Asymptomatic” patients were those with sinistral hypertension alone. Results: Sinistral portal hypertension was present in 34 of the 484 patients (7%). Gastric or gastroesophageal varices were confirmed in 12 patients (35%), of whom 6 had variceal bleeding and 4 had hypersplenism (25%). All symptomatic patients were treated by splenectomy alone or in conjunction with distal pancreatectomy. Splenectomy at the time of pancreatectomy for primary pancreatic symptoms was also performed in 15 patients with (asymptomatic) sinistral portal hypertension. None of the 23 patients who had splenectomy rebled in mean follow-up of 4.8 years. In contrast, 1 of the 11 patients with asymptomatic sinistral portal hypertension who underwent pancreatic surgery without splenectomy died of later variceal bleeding 3 years after lateral pancreatojejunostomy. Conclusions: Symptomatic sinistral portal hypertension is best treated by splenectomy. Concomitant splenectomy should be strongly considered in patients undergoing operative treatment of symptomatic chronic pancreatitis if sinistral portal hypertension and gastroesophageal varices are also present.

The significance of sinistral portal hypertension complicating chronic pancreatitis.

Most cases of pancreatitis are mild and selflimited. On the other hand, approximately one quarter of patients with pancreatitis may develop vascular complications. Vascular complications in pancreatitis are well recognized. Their exact incidence is not known. The most common complications are haemorrhage into a pseudocyst, erosions of the upper gastrointestinal arteries, thromboses of the portal venous system, formation of varices or pseudoaneurysms and rupture of a pseudoaneurysm. Pancreatitis in combination with vascular complications is dangerous and potentially lethal. The survival of patients with pancreatitis and vascular complications depends on the early diagnosis of these complications. This article focuses on the aetiology, presentation, recent developments in diagnosis and management of such complications.

/pdf/vascular-complications-of-pancreatitis-jsqgxdgyvz.pdf

Vascular complications of pancreatitis

Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.

https://pubs.rsna.org/doi/pdf/10.1148/radiographics.22.1.g02ja20123?frame=header

Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls.

OBJECTIVE. The aims of this study were to present the prevalence, imaging and clinical findings, and possible causes of portal venous system aneurysms.MATERIALS AND METHODS. From 1998 to 2006, a total of 38 portal venous system aneurysms identified in 25 patients were retrospectively reviewed. The data of seven patients diagnosed using color Doppler sonography or CT before March 2004 were not consecutive, but the data recorded thereafter comprised the analysis of 4,186 consecutive patients who underwent routine abdominal MDCT. The patients were 14 men and 11 women (mean age ∓ SD, 53 ∓ 17 years).RESULTS. The prevalence of portal venous system aneurysm among 4,186 consecutive patients was 0.43%. There were no differences with respect to patient age, patient sex, and intrahepatic or extrahepatic location of aneurysm between those with and those without portal venous system aneurysm. Seven of the 25 patients with portal venous system aneurysm were symptomatic because of portal vein thrombosis, and six of them...

https://www.ajronline.org/doi/pdf/10.2214/AJR.07.2121

Portal venous system aneurysms: imaging, clinical findings, and a possible new etiologic factor.

Portal vein aneurysm is very rare, and its relation to portal hypertension has been emphasized. We report six cases of portal vein aneurysm (five extrahepatic and one intrahepatic). All patients were asymptomatic and had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound. Color Doppler sonography showed a constant hepatopetal flow along the aneurysmal wall, which immediately led to the diagnosis. We stress the usefulness of color Doppler sonography for studying the hemodynamics of this vascular anomaly and briefly review the literature.

Portal vein aneurysm: report of six cases and review of the literature

Background: Compared with esophageal varices, gastrointestinal varices are relatively rare, but they are clinically important because they tend to bleed massively. Color Doppler sonography is now widely used to diagnose the collaterals, but few color Doppler findings of gastric or intestinal varices have been reported. The aim of this study was to investigate the sonographic and color Doppler findings of gastrointestinal varices and to determine the role of color Doppler sonography in the diagnosis of these varices.

Color Doppler findings of gastrointestinal varices.

Portal hypertension is a relatively uncommon pathologic condition in children and young adults in contrast with older adults. The aim of this study is to evaluate the utility of sonography and color Doppler sonography in the diagnosis of portal hypertension in children and young patients and to evaluate the sonographic pattern of each disease. We reviewed 25 such patients who were younger than 30 years old and obtained the following sonographic findings: (1) liver cirrhosis: (a) multiple intrahepatic venovenous shunts in patients with primary Budd-Chiari syndrome and (b) intrahepatic vascular narrowing and nodular coarse parenchymal texture, with multiple very-high-echo spots along the portal vein in patients with Wilson disease; (2) congenital hepatic fibrosis: marked and developed collaterals, wide periportal echogenic band, and a heterogeneous parenchymal texture comprised of multiple high echoes but without portal thrombus; and (3) extrahepatic portal thrombosis: invisible portal lumen except as an echogenic band. Sonography and color Doppler sonography are very useful in diagnosing these portal hypertensive diseases. However, there are no specific sonographic findings, and the role of sonography is limited to follow-up observation of associated secondary hepatobiliary changes in patients with congenital biliary atresia.

Portal hypertension in children and young adults: sonographic and color Doppler findings.

Extrahepatic portosystemic shunt usually occurs secondary to severe portal hypertension, and it is rare to encounter it in patients without portal hypertension. We report herein a large extrahepatic portosystemic shunt between the left gastric vein and left renal vein without portal hypertension in which color Doppler sonography was useful not only for detection but evaluation of the effect of embolization.

Large extrahepatic portosystemic shunt without portal hypertension.

Objective

To evaluate, using microcomputer simulation models, the degree of distortion of the puncture needle in sonograms used during a liver puncture under ultrasound guidance.



Methods

We made a simplified simulation model of the puncture needle passing through the abdominal wall to the target lesion in the liver (cases without ascites), and additionally through ascites between the abdominal wall and the liver (cases with ascites), to evaluate the degree of distortion of the puncture needle in the sonogram. We considered the thicknesses and sound velocities of the abdominal wall and the ascites fluid, as well as the puncture angle, on the degree of distortion.



Results

(1) Cases without ascites: The puncture needle displayed on sonogram shifted predominantly anteriorly with a displacement error between 6 mm forward and 1 mm backward and with an angular error between 2.2 degrees forward and 0.1 degree backward when the abdominal wall was muscular, and the pattern of distortion had an inverted S-shape. It was displayed predominantly posteriorly with a displacement error between 14 mm backward and 2 mm forward and with an angular error between 3.7 degrees backward and 1.2 degrees forward when the abdominal wall was fatty, and the pattern was S-shaped. Regardless of the composition of the abdominal wall, when the abdominal wall was thin, the more obtuse the puncture angle was, the larger the shift was, and when the abdominal wall was thick, the more acute the puncture angle was, the larger the shift was.



(2) Cases with ascites: (a) Regardless of the quantity and sound velocity of the ascites, the puncture needle shifted predominantly anteriorly with a displacement error between 7 mm forward and 3 mm backward and with an angular error between 3.1 degrees forward and 1.9 degrees backward when the abdominal wall was muscular, and showed the inverted S-shaped pattern. In contrast, it shifted predominantly posteriorly with a displacement error between 17 mm backward and 5 mm forward and with an angular error between 3.7 degrees backward and 3.9 degrees forward when the abdominal wall was fatty, and showed the S-shaped pattern. (b) Regardless of the sound velocity of the ascites fluid and the composition of the abdominal wall, the shift of the puncture needle changed little with differing amounts of ascites.



Conclusion

It is highly recommended that a liver puncture under US guidance be performed taking into account the pattern of distortion of the puncture needle in each situation. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound25: 127–132, 1997.

Accuracy of liver puncture under US guidance: re-evaluation by microcomputer simulation model.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Y. Ohnami

Author Tools

Chat about Author