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Higashi S, Nakabori T, Mukai K, Seiki Y, Watsuji K, Hirao T, Kawamoto Y, Urabe M, Kai Y, Takada R, Yamai T, Ikezawa K, Uehara H, Ohkawa K. Portal Vein Aneurysm in a Patient with Cirrhosis Type C Controlled by Direct-Acting Antiviral Treatment. Case Rep Gastroenterol 2024; 18:74-80. [PMID: 38371742 PMCID: PMC10871735 DOI: 10.1159/000535957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/12/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Portal vein aneurysm (PVA) is a rare saccular or fusiform portal vein dilatation. The management and optimal treatment of PVA remain unknown. Case Presentation A 53-year-old man with hepatitis C virus (HCV) infection was diagnosed with PVA measuring 28 mm in diameter. Under observation, his liver fibrosis progressed, and the PVA diameter gradually increased to 52 mm. The patient was treated with elbasvir-grazoprevir for 12 weeks, and HCV disappeared. After achieving sustained virological response, liver fibrosis improved and the PVA progression ceased. Conclusion HCV clearance by direct-acting antiviral treatment not only regressed liver fibrosis but may have also restrained the progression of PVA in a patient with cirrhosis type C and PVA.
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Affiliation(s)
- Sena Higashi
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tasuku Nakabori
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kaori Mukai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusuke Seiki
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ko Watsuji
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takeru Hirao
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuharu Kawamoto
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Makiko Urabe
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yugo Kai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takuo Yamai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Uehara
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
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Kurtcehajic A, Zerem E, Alibegovic E, Kunosic S, Hujdurovic A, Fejzic JA. Portal vein aneurysm-etiology, multimodal imaging and current management. World J Clin Cases 2023; 11:725-737. [PMID: 36818612 PMCID: PMC9928716 DOI: 10.12998/wjcc.v11.i4.725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases. In the last seven years, there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging. The aim of this review is to provide a comprehensive update of PVA, including aetiology, epidemiology, and clinical assessment, along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.
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Affiliation(s)
- Admir Kurtcehajic
- Department of Gastroenterology and Hepatology, Plava Medical Group, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
| | - Enver Zerem
- Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo 71000, Bosnia and Herzegovina
| | - Ervin Alibegovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
| | - Suad Kunosic
- Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
| | - Ahmed Hujdurovic
- Department of Internal Medicine, Plava Medical Group, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
| | - Jasmin A Fejzic
- Department of Internal Medicine, General Hospital Tesanj, Tesanj 74260, Bosnia and Herzegovina
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Ahmed O, Ohman JW, Vachharajani N, Yano M, Sanford DE, Hammill C, Fields RC, Hawkins WG, Strasberg SM, Doyle MB, Chapman WC, Khan AS. Feasibility and safety of non-operative management of portal vein aneurysms: a thirty-five year experience. HPB (Oxford) 2021; 23:127-133. [PMID: 32561177 DOI: 10.1016/j.hpb.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Portal vein aneurysms (PVAs) are rare, though clinically challenging with post-operative mortality approaching 20% and no evidence-based treatment guidelines. We aim to describe our experience with PVAs and recommend optimum management strategies. METHODS Demographics and clinical details of patients with PVAs admitted to our institution from 1984 to 2019 were reviewed. Clinical presentation, management and outcomes were analysed. RESULTS PVAs were identified in 18 patients (median age 56 years, range 20-101 years; 13 female); 10 were incidental and 8 diagnosed during abdominal pain work-up. Median aneurysm diameter at diagnosis was 3.4 cm (1.8-5.5 cm), remaining unchanged at 3.5 cm (1.9-4.8 cm) during a 3.2-year follow-up (4 months-31 years). Aneurysm sites were the main portal vein (n = 12), porto-splenic-junction (n = 3), splenic-SMV-junction (n = 2) and right portal vein (n = 1). Thrombosis occurred in 4 patients; 3 developed clinically insignificant cavernous transformation. Two patients underwent surgery for abdominal pain. Postoperatively, one developed PV thrombosis and PVA recurrence occurred in the second. No aneurysm ruptures or mortalities occurred during follow-up. CONCLUSION PVAs follow a clinically indolent course with structural stability and minimal complications over time. Non-operative management is feasible for most patients. Abdominal pain, large size or thrombosis don't appear to confer additional risks and should not, in isolation, merit surgical intervention.
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Affiliation(s)
- Ola Ahmed
- Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - John W Ohman
- Department of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Neeta Vachharajani
- Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Motoyo Yano
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Dominic E Sanford
- Department of Hepatobiliary, Pancreatic, And Gastrointestinal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Chet Hammill
- Department of Hepatobiliary, Pancreatic, And Gastrointestinal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Hepatobiliary, Pancreatic, And Gastrointestinal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - William G Hawkins
- Department of Hepatobiliary, Pancreatic, And Gastrointestinal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Strasberg
- Department of Hepatobiliary, Pancreatic, And Gastrointestinal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria B Doyle
- Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - William C Chapman
- Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Adeel S Khan
- Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA.
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