Korean J Hepatobiliary Pancreat Surg.  2016 May;20(2):81-84. 10.14701/kjhbps.2016.20.2.81.

Management of portal hypertension derived from uncommon causes

• Kim SH
• Lee HM
• Lee SH
• Won JY
• Kim KS

• KMID: 2243020
• DOI: http://doi.org/10.14701/kjhbps.2016.20.2.81

Abstract

Portal hypertension can arise from any condition interfering with normal blood flow at any level within the portal system. Herein, we presented two uncommon cases of the portal hypertension and its treatment with brief literature review. A 71-year-old man who underwent right hemihepatectomy revealed a tumor recurrence adjacent to the inferior vena cava (IVC). After radiofrequency ablation (RFA) with lymph node dissection, he was referred for abdominal distension. The abdomen computed tomography scan showed severe ascites with a narrowing middle hepatic vein (MHV) and IVC around the RFA site. After insertion of two stents at the IVC and MHV, the ascites disappeared. Another 73-year-old man underwent right trisectionectomy of liver and segmental resection of the portal vein (PV). After operation, he underwent conservative management due to continuous abdominal ascites. The abdomen computed tomography scan showed severe ascites with obliteration of the left PV. After insertion of stent, the ascites disappeared. A decrease of the pressure gradient between the PV and IVC is one of the important treatment strategies for portal hypertension. Vascular stent is useful in the reduction of pressure gradient and thus, can be a treatment option for portal hypertension.

Keyword

Portal hypertension; Radiofrequency ablation; Stenosis; Stents

MeSH Terms

Abdomen
Aged
Ascites
Catheter Ablation
Constriction, Pathologic
Hepatic Veins
Humans
Hypertension, Portal*
Liver
Lymph Node Excision
Portal System
Portal Vein
Recurrence
Stents
Vena Cava, Inferior

Figure

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  Fig. 1 Computed tomography of the case 1 shows the amount of ascites with abdominal distension.

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  Fig. 2 Angiographic finding of the case 1. (A) There is a narrowing IVC without hepatic outflow (arrowhead). (B) After stenting, widening of the IVC with outflow of hepatic vein is seen.

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  Fig. 3 Computed tomography of the case 2 shows left portal vein thrombosis with amount of ascites (arrow).

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  Fig. 4 Angiographic finding of the case 2. (A) There is an obliterated left portal vein with collateral formation (arrowhead). (B) After stenting, widening of the left portal vein is seen.

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