Purpose:To evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt(TmEPS)for the treatment of cavernous transformation of the portal vein(CTPV).Materials and methods:The clinic...Purpose:To evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt(TmEPS)for the treatment of cavernous transformation of the portal vein(CTPV).Materials and methods:The clinical data of 20 patients with CTPV who underwent TmEPS between December 2020and January 2022 at Henan Provincial People’s Hospital were retrospectively collected.The superior mesenteric vein(SMV)trunk was patent or partially occluded in these patients.An extrahepatic portosystemic shunt between the inferior vena cava and the SMV was established using a stent graft through an infraumbilical median longitudinal mini-laparotomy.The technical success,efficacy,and complication rates were evaluated,and the preand postoperative SMV pressures were compared.Patients’clinical outcomes and shunt patency were assessed.Results:TmEPS was successfully performed in 20 patients.The initial puncture success rate of the balloon-assisted puncture technique is 95%.The mean SMV pressure decreased from 29.1±2.9 mmHg to 15.6±3.3 mmHg(p<0.001).All symptoms of portal hypertension resolved.No fatal procedural complications occurred.During the follow-up period,hepatic encephalopathy occurred in two patients.The remaining patients remained asymptomatic.All shunts were patent.Conclusions:TmEPS is a feasible,safe,and effective treatment option for patients with CTPV.展开更多
Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for sy...Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for systemic diversion of portal blood have been proposed.A one-step interventional approach,combining minilaparotomy-assisted transmesenteric(MAT)antegrade portal recanalization and TIPS,is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC).A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC.A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed.In the case of failed portal recanalization,this approach,would also be useful for varice endovascular embolization.Postoperative recovery was uneventful.Treatment consisting of propanolol,enoxaparin and a proton pump inhibitor was prescribed after the procedure.One month post-op,contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts.No residual peritoneal fluid was detected nor opacification of the large varices.Endoscopy showed good improvement of the varices.Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches.Three months post-op,TIPS maintained its hourglass shape despite a slight expansion.Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization.MAT-TIPS is feasible and safe for the treatment of PC even in children.This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.展开更多
BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is n...BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is not widely known among clinicians,and it is easily misdiagnosed,resulting in disastrous effects.CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer.The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first.Then,the patient’s symptoms were aggravated and he presented in a shock-like state.Computed tomography revealed a suspected internal hernia,extensive small intestinal obstruction,and massive effusion in the abdominal and pelvic cavity.Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve,and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis.The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.CONCLUSION In this report,we review the pathogenesis,presentation,diagnosis,and treatment of congenital transmesenteric hernia in children.展开更多
基金supported by the Henan medical science and technology research projects(222102310014)
文摘Purpose:To evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt(TmEPS)for the treatment of cavernous transformation of the portal vein(CTPV).Materials and methods:The clinical data of 20 patients with CTPV who underwent TmEPS between December 2020and January 2022 at Henan Provincial People’s Hospital were retrospectively collected.The superior mesenteric vein(SMV)trunk was patent or partially occluded in these patients.An extrahepatic portosystemic shunt between the inferior vena cava and the SMV was established using a stent graft through an infraumbilical median longitudinal mini-laparotomy.The technical success,efficacy,and complication rates were evaluated,and the preand postoperative SMV pressures were compared.Patients’clinical outcomes and shunt patency were assessed.Results:TmEPS was successfully performed in 20 patients.The initial puncture success rate of the balloon-assisted puncture technique is 95%.The mean SMV pressure decreased from 29.1±2.9 mmHg to 15.6±3.3 mmHg(p<0.001).All symptoms of portal hypertension resolved.No fatal procedural complications occurred.During the follow-up period,hepatic encephalopathy occurred in two patients.The remaining patients remained asymptomatic.All shunts were patent.Conclusions:TmEPS is a feasible,safe,and effective treatment option for patients with CTPV.
文摘Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for systemic diversion of portal blood have been proposed.A one-step interventional approach,combining minilaparotomy-assisted transmesenteric(MAT)antegrade portal recanalization and TIPS,is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC).A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC.A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed.In the case of failed portal recanalization,this approach,would also be useful for varice endovascular embolization.Postoperative recovery was uneventful.Treatment consisting of propanolol,enoxaparin and a proton pump inhibitor was prescribed after the procedure.One month post-op,contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts.No residual peritoneal fluid was detected nor opacification of the large varices.Endoscopy showed good improvement of the varices.Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches.Three months post-op,TIPS maintained its hourglass shape despite a slight expansion.Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization.MAT-TIPS is feasible and safe for the treatment of PC even in children.This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.
基金Zhejiang Province Public Welfare Technology Application Research Project,No.LGF21H160022and Project of Taizhou Central Hospital,No.2019KT003.
文摘BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is not widely known among clinicians,and it is easily misdiagnosed,resulting in disastrous effects.CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer.The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first.Then,the patient’s symptoms were aggravated and he presented in a shock-like state.Computed tomography revealed a suspected internal hernia,extensive small intestinal obstruction,and massive effusion in the abdominal and pelvic cavity.Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve,and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis.The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.CONCLUSION In this report,we review the pathogenesis,presentation,diagnosis,and treatment of congenital transmesenteric hernia in children.
