Presentation
Symptoms are generally nonspecific at presentation. Patients may present with abdominal pain, nausea, vomiting, or diarrhea. While rare, gastrointestinal bleeding, ascites, and mesenteric ischemia are some of the more alarming presentations [5]. [cureus.com]
The abdominal lump and bruit were still present but there was no ascites. The haemogram, renal and liver function tests were within normal limits. [ncbi.nlm.nih.gov]
Case Presentation A 75-year-old woman presented to an outside hospital with hematochezia and hematemesis. She had a surgical history of two small bowel resections four and six years prior to presentation. [cvirendovasc.springeropen.com]
We present an unusual case of a 34-year-old man presented with melena, initially thought to be secondary to bleeding varices from cirrhosis related to hepatitis B virus (HBV) infection. [scielo.isciii.es]
Very recent data based on experimental and clinical research projects are presented. The contributions have all been written by a team of internationally well recognized authorities in the various fields involved. [books.google.com]
Entire Body System
- Surgical Procedure
This book aims to comprehensibly describe the minimally invasive technique including robot assisted procedures of upper abdominal cancer, including aspects such as surgical anatomy, neoadjuvant therapy and minimally invasive surgical technique, and robot [books.google.es]
However, it helped to stabilize the patient, restore normal liver function and allowed a delayed elective surgical procedure. To conclude, post-traumatic aorto-portal fistula is a rare complication. [ncbi.nlm.nih.gov]
Surgical procedures Surgical Procedures are now seldom required for variceal bleeding and are used only when other measures fail. These procedures include local devascularisation procedures and porta-systemic shunts. [surgwiki.com]
Iatrogenic AVFs between inferior mesenteric artery (IMA) and vein (IMV) can occur after arterial catheterization or various surgical procedures such as a sigmoidectomy or left hemicolectomy [ 1, 6 ]. [astr.or.kr]
Surgical procedures Surgical portosystemic shunts: [ 14 ] These require major surgery and an experienced surgeon. They are less likely to stenose than TIPS and can be used where TIPS is not feasible. Shunts may be total, partial or selective. [patient.info]
- Anemia
She was believed to have chronic iron losses due to prior vaginal bleeding exacerbated by physiologic anemia of pregnancy. Her anemia was responsive to oral and intravenous iron supplementation and stabilized at 11.8 g/dL. [acgcasereports.gi.org]
A preliminary blood work-up revealed macrocytic anemia with 8.7g/dL hemoglobin and 137.1fL mean corpuscular volume. [jmedicalcasereports.biomedcentral.com]
[…] back-references to 573.8 : Cholestasis 576.8 due to total parenteral nutrition (TPN) 573.8 Cyst (mucus) (retention) (serous) (simple) falciform ligament (inflammatory) 573.8 liver 573.8 Deformity 738.9 Degeneration, degenerative Gangrene, gangrenous (anemia [icd9data.com]
These may be intrahepatic or extrahepatic in location and present during infancy or early childhood with portal hypertension and gastrointestinal bleeding secondary to varices, ascites, malabsorption, anemia, and congestion of the bowel (5). [journals.lww.com]
The laboratory tests disclosed the following values: Decreased red blood cells (3.28 × 10^12/L), hemoglobin (87 g/L) and albumin (32.4 g/L) levels suggested anemia; elevated prothrombin time (PT 15.1 s), activated partial thromboplastin time (APTT 45.6 [scielo.isciii.es]
- Fever
There were no complaints of fever, loss of weight, loss of appetite, or gastrointestinal bleeding. [journals.lww.com]
These patients are very sick and have fever, watery-bloody diarrhea and neutropenia. Neutropenia is an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections, particularly those caused by bacteria and fungi. [radiologyassistant.nl]
Figure 1A: Air in the liver was thought to be in branches of the portal vein Figure 2 Figure 1B: Air in portal vein more centrally Figure 3 Figure 1C: Air seen in Inferior Mesenteric Vein A 56-year-old man was seen for a ten-day history of chills and fever [ispub.com]
[…] disease cirrhosis Budd-Chiari syndrome acute viral hepatitis Elevation of serum bilirubin results in: hepatocellular disease ascites jaundice hemolysis Typical symptoms a patient may have with an abscess formation include all of the following EXCEPT: fever [quizlet.com]
Abdominal pain and fever - suggest spontaneous bacterial peritonitis. [patient.info]
- Gangrene
gangrenous (anemia) (artery) (cellulitis) (dermatitis) (dry) (infective) (moist) (pemphigus) (septic) (skin) (stasis) (ulcer) 785.4 liver 573.8 Hematoma (skin surface intact) (traumatic) - see also Contusion liver (subcapsular) 573.8 Hemorrhage, hemorrhagic [icd9data.com]
An emergent laparotomy revealed mesenteric gangrene with perforation, and a bowel resection with ileostomy and mucus fistula creation was performed. [jmedicalcasereports.biomedcentral.com]
[…] to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role. [27] If the ischemia has progressed to the point that the affected intestinal segments are gangrenous [en.wikipedia.org]
On the other hand, gangrene [ 34 ] or perforation [ 34, 35, 36 ] of the bowel ensues if the inciting ischemic injury is severe. The gut mucosa may reveal ulceration and there may be associated mesenteric panniculitis [ 32 ]. [pancreas.imedpub.com]
Gastrointestinal
- Diarrhea
Case Report: The 45-year-old male was admitted with bloody diarrhea, fatigue, weight loss and moderate ascites. [ncbi.nlm.nih.gov]
Case Presentation A 54-year-old man was evaluated for abdominal pain, tenesmus and bloody diarrhea. [clinmedjournals.org]
In addition, he admitted to nausea, vomiting, and mild non-bloody diarrhea. Vital signs were within normal limits. [cureus.com]
Clinical Indications : Abdominal pain associated with eating Fear of food Chronic diarrhea Unexplained weight loss Duplex/color scanning is utilized to evaluate the celiac, superior mesenteric, and inferior mesenteric arteries for hemodynamically significant [pacificvascular.com]
Patients may be asymptomatic or may present with crampy abdominal pain with or without diarrhea, portal hypertension, liver impairment, and even gastrointestinal bleeding (1). [scielo.isciii.es]
- Hematemesis
Superior mesenteric arteriovenous fistula causing massive hematemesis. Surgery 2003;134:102-4. DOI: 10.1067/msy.2003.11. [ Links ] 8. Wu CG, Li YD, Li MH. [scielo.isciii.es]
Superior mesenteric arteriovenous fistula causing massive hematemesis. Surgery 2003; 134 :102–104. 3. Wood M, Nykamp PW. Traumatic arteriovenous fistula of the superior mesenteric vessels. J Trauma 1980; 20 :378–382. 4. Salimov DR, Ignat'ev IM. [nature.com]
Despite the fact that AVF was ultimately recognized, uncontrollable hypovolemic shock caused by hematemesis, precluded the probable efficiency of further therapeutic attempts. [ncbi.nlm.nih.gov]
Case Presentation A 75-year-old woman presented to an outside hospital with hematochezia and hematemesis. She had a surgical history of two small bowel resections four and six years prior to presentation. [cvirendovasc.springeropen.com]
In the series described by Agrawal et al. only 15% of patients with CP associated SV thrombosis presented with hematemesis [ 10 ]. [pancreas.imedpub.com]
Cardiovascular
- Vascular Disease
Disease ................. 11 Christopher K. [books.google.com]
CT and MR Angiography: Comprehensive Vascular Assessment. Lippincott Williams & Wilkins. p. 318. ISBN 9781469801834. Archived from the original on 2017-09-08. ^ a b Gustavo S. Oderich (2014). Mesenteric Vascular Disease: Current Therapy. [en.wikipedia.org]
In non GIT cause such as vascular disease or when the problem cannot be managed laparoscopically, laparotomy is indicated. [wjes.biomedcentral.com]
Skin
- Flushing
Flush abdominal aortogram shows retrograde flow through the arc of Riolan from the IMA to the SMA (arrow), and subsequently to the portal vein via the fistula. Fig. 4. A 9-mm balloon is placed across the origin of the fistula. [members.sirweb.org]
Using standard catheter and guidewire technique, a 5 French Omni Flush catheter was advanced to the suprarenal abdominal aorta, and digital subtraction angiography was performed. [cureus.com]
Psychiatrical
- Suggestibility
For complications of portal hypertension: Haematemesis or melaena - suggest bleeding varices. Lethargy, irritability and changes in sleep pattern - suggest encephalopathy. Increased abdominal girth, weight gain - suggest ascites. [patient.info]
The development of an abdominal bruit in a patient with penetrating abdominal trauma suggests APF and should prompt angiography. Elective repair is recommended before complications of portal hypertension develop. ( Arch Surg 1987;122:563-571) [jamanetwork.com]
A CT scan demonstrated a massively dilated portal vein which enhanced during the arterial phase, suggesting a fistula between the mesenteric arterial system and the portal vein. [members.sirweb.org]
Immune markers were suggested to be present in chronic ischemic colitis [ 47 ]. [clinmedjournals.org]
The subsequent normalisation suggested that the hepatic arterial flow had returned to normal volume. [ncbi.nlm.nih.gov]
Workup
Through this case report, we hope to highlight awareness of this unusual condition, discuss the diagnostic workup and our management approach. [wjgnet.com]
Further workup revealed a large SMAVF as the cause of severe portal hypertension and gastroesophageal varices. Case Report A 34-year-old man presented with melena, without complaints of chronic abdominal pain. [scielo.isciii.es]
Biopsy
- Liver Biopsy
Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices. [rihuc.huc.min-saude.pt]
Two APFs developed after percutaneous liver biopsy, but only one was complicated (hemobilia). Neither patient was treated operatively. Four APFs occurred two days to three years after gunshot wounds. [jamanetwork.com]
biopsy and other hepatic intervention may be due to liver cirrhosis itself owing to deformation of hepatic sinusoids which increases arterial pressure or portal vein extrinsic compression that also lead to increased arterial pressure c ongenital intrahepatic [radiopaedia.org]
Treatment
TY - JOUR T1 - Combined transhepatic portal venous and transarterial treatment of superior mesenteric arteriovenous fistula in a patient with cirrhosis. [unboundmedicine.com]
(April 06, 2021) Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia. [cureus.com]
Topics of parti- cular interest include feed-back regulation, new aspects of conservative and interventional treatment as well as modern surgical approaches including organ-preserving procedures. [books.google.com]
Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis. Hepatology. 2002; 35 :609–15. [ PubMed ] [ Google Scholar ] [ncbi.nlm.nih.gov]
Therefore, a surgical treatment was considered to be the only suitable treatment for such severe ascites. Laparoscopic low anterior resection including APF in the mesorectum was performed using five ports. [sages.org]
Prognosis
Portal venous gas is often associated with a dismal prognosis, since it is related to extensive intestinal necrosis in 75% of all the cases [ 2 ]. [em-consulte.com]
Prognosis This depends on the prognosis of the underlying disease, and on the outcome of any complications such as variceal bleeding. [patient.info]
Gas in portal vein is a good predictive factor for diagnosis, management, and prognosis [ 56 ]. In the past the traditional teaching is to operate once you have radiological evidence of PVG. [wjes.biomedcentral.com]
Often, obviously dead segments are removed at the first operation, and a second-look operation is planned to assess segments that are borderline that may be savable after revascularization. [28] Prognosis [ edit ] The prognosis depends on prompt diagnosis [en.wikipedia.org]
The correct diagnosis and characterization of PVT is important for the prognosis and further treatment. [7] Portal vein tumor thrombosis (PVTT) is a poor prognostic indicator, which is found at diagnosis in 10-40% of patients with hepatocellular carcinoma [emedicine.medscape.com]
Etiology
AVFs can occur as a result of blunt or penetrating traumas such as a gunshot or stab wound [ 1, 7 ] or idiopathic etiology [ 3, 4, 5 ]. [astr.or.kr]
This volume deals with all aspects of CHRONIC PANCREATITIS including epidemiology, etiology, morphology and pathophysiology, dia- gnostic imaging as well as conservative and operative treat- ment. [books.google.com]
Conclusions This report highlights a potential etiology of variceal bleeding in the acutely ill patient. [cvirendovasc.springeropen.com]
Congenital etiologies often result in the formation of multiple AVFs[ 2 ], which are components of Osler-Weber-Rendu and Ehlers-Danlos syndromes[ 1, 9 ]. [ncbi.nlm.nih.gov]
Epidemiology
This volume deals with all aspects of CHRONIC PANCREATITIS including epidemiology, etiology, morphology and pathophysiology, dia- gnostic imaging as well as conservative and operative treat- ment. [books.google.com]
View Article Google Scholar Alqahtani S, Coffin CS, Burak K, Chen F, MacGregor J, Beck P: Hepatic portal venous gas: a report of two cases and a review of the epidemiology, pathogenesis, diagnosis and approach to management. [wjes.biomedcentral.com]
Pathophysiology
Detailed attention is paid to pathophysiology, clinical symptoms and findings, all relevant imaging modalities and other tests employed to evaluate abdominal injuries at the time of admission of the trauma victim. [books.google.de]
vii Contributors ............. .. .. .. .. .. .. .. .. .. .. .. .. .. .. xiii PART I INTRODUCTION 1 Evolution of Endovascular Therapy: Diagnostics and Therapeutics ....................... 3 Thomas 1 Fogarty and Amitava Biswas 2 Pathophysiology [books.google.com]
"Pathophysiology of Portal Hypertension and Esophageal Varices". International Journal of Hepatology. 2012 : 1–7. doi : 10.1155/2012/895787. PMC 3362051. [en.wikipedia.org]
Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit. Kim M, Lee KY. Kim M, et al. Biomed Res Int. 2016;2016:2097363. doi: 10.1155/2016/2097363. Epub 2016 Oct 27. Biomed Res Int. 2016. [pubmed.ncbi.nlm.nih.gov]
Prevention
Endoscopic vein ligation - to prevent bleeding of oesophageal varices. [patient.info]
Prevention of recurrent bleeding Once the initial bleeding has ceased, measures are instigated to prevent recurrence. These include prophylactic banding or sclerotherapy and the use of pharmacological agents such as oral β-blockers. [surgwiki.com]
In Asia it is routine to administer IV haptoglobin, which binds free hemoglobin, to prevent hemolysis-induced kidney damage. [radiologykey.com]
The goal of the treatment is to cure pre-hepatic portal hypertension and prevent associated complications. [ncbi.nlm.nih.gov]