Bile Duct Varices

Spira, Richard; Widrich, Warren C.; Keusch, Kenneth D.; Jackson, Benjamin T.; Katzman, Howard E.; Coello, Abilio A.

doi:10.1001/archsurg.1985.01390340086018

Cited by 34 publications

(18 citation statements)

References 8 publications

(2 reference statements)

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“…9 Such varices are sometimes detected in the venous phase of superior mesenteric angiography; 2-4 however, the jejunal varices in our patient were not detected in the venous phase of superior mesenteric arteriography because of the welldeveloped portal collateral veins in the hepatoduodenal ligament. They were also not able to be detected by conventional enhanced helical CT scan.…”

Section: Discussioncontrasting

confidence: 49%

“…The resulting varices in the afferent loop can rupture and bleed. 4,8 Stenosis or obstruction of the extrahepatic portal vein can result from thrombophlebitis associated with infection, compression or direct invasion of the portal vein by a tumor, thrombosis caused by portal stasis associated with hepatic cirrhosis, 9 or adhesions from a previous operation. 10 The most likely reason for the variceal formation in our patient was obstruction of the right portal trunk by infl ammation with adhesion formation in response to bile leakage after his second operation.…”

Section: Discussionmentioning

confidence: 99%

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Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case

et al. 2010

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We report a case of successful embolization of jejunal varices that were the cause of massive gastrointestinal bleeding from a choledochojejunostomy site, resulting from obstruction of the extrahepatic portal vein. A 42-year-old man who had undergone choledochojejunostomy for intrahepatic and choledochal stones was readmitted after he started passing massive dark bloody stools. Gastrointestinal endoscopic examination and angiography could not identify the source of bleeding. Percutaneous transhepatic portography showed obstruction of the right branches of the portal vein. The formation of jejunal varices at the site of choledochojejunostomy was revealed by portography and by cholangioscopy, suggesting the varices as the cause of massive bleeding. Bleeding could not be controlled long-term by cholangioscopic sclerosing therapy. We finally stopped the bleeding by embolizing a jejunal vein to the afferent loop.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case

et al. 2010

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“…[10][11][12] In some cases with complete PVT, a large coronary vein or a big periportal varix have been used for anastomosis with the donor portal vein. [13][14][15] Portal flow can be improved by ligating the coronary vein to prevent the steal of portal blood flow. In addition, to improve portal blood flow, arterialization of the portal vein with the recipient splenic artery has been reported, as well as interposition of a venous graft between the coronary vein and recipient portal vein.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in patients with portal vein thrombosis

Manzanet¹,

Sanjuan²,

Orbis³

et al. 2001

Liver Transpl

167

126

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The aim of this study is to analyze the incidence, risk factors, management, and follow-up of patients with portal vein thrombosis (PVT) undergoing primary orthotopic liver transplantation (OLT). Four hundred fifteen OLTs were performed in 391 patients. In 62 patients, partial (group 1; n ‫؍‬ 48) or complete (group 2; n ‫؍‬ 14) PVT was found at the time of surgery. Portal flow was reestablished by venous thrombectomy. In this study, we compare 62 primary OLTs performed in patients with PVT at the time of OLT with a group of 329 primary OLTs performed in patients without PVT (group 3) and analyze the incidence of PVT, use of diagnostic methods, surgical management, and outcome. We found no significant differences among the 3 groups for length of surgery, cold and warm ischemic times, and postoperative stay in the intensive care unit. With the piggyback technique, groups 1 and 2 had greater blood losses and required more blood transfusions than group 3. The early reoperation rate was greater in group 2. The incidence of rethrombosis was 4.8% (group 1, 2%; group 2, 14.3%). Reexploration and thrombectomy (2 patients) and retransplantation (1 patient) had a 100% mortality rate. In particular, the mortality rate of patients with complete PVT with extension into the splanchnic veins is high (33%). Three-month and 4-year patient survival rates were statistically similar in the 3 groups. The presence of PVT at the time of OLT is not a contraindication for OLT. However, if PVT extends into the splanchnic veins, the outcome is guarded. (Liver Transpl 2001;7:125-131.)

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“…Choledochal varices were first demonstrated on cholangiography by Williams in 1982, 12 which was later confirmed by other workers. 13,14 That collateral decompression by portosystemic shunt (PSS) surgery can lead to reversal of biliary obstruction was first reported in 1988, 15 an observation corroborated and qualified subsequently. 16,17 The era of endoscopic management in this condition began in 1993 with the first report of endoscopic biliary stenting in this condition.…”

Section: Historical Perspective Nomenclature and Definitionmentioning

confidence: 97%

Portal Cavernoma Cholangiopathy: Consensus Statement of a Working Party of the Indian National Association for Study of the Liver

Dhiman

Saraswat

Valla

et al. 2014

Journal of Clinical and Experimental Hepatology

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Portal cavernoma cholangiopathy (PCC) is defined as abnormalities in the extrahepatic biliary system including the cystic duct and gallbladder with or without abnormalities in the 1st and 2nd generation biliary ducts in a patient with portal cavernoma. Presence of a portal cavernoma, typical cholangiographic changes on endoscopic or magnetic resonance cholangiography and the absence of other causes of these biliary changes like bile duct injury, primary sclerosing cholangitis, cholangiocarcinoma etc are mandatory to arrive a diagnosis. Compression by porto-portal collateral veins involving the paracholedochal and epicholedochal venous plexuses and cholecystic veins and ischemic insult due to deficient portal blood supply or prolonged compression by collaterals bring about biliary changes. While the former are reversible after porto-systemic shunt surgery, the latter are not. Majority of the patients with PCC are asymptomatic and approximately 21% are symptomatic. Symptoms in PCC could be in the form of long standing jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones. Endoscopic retrograde cholangiography has no diagnostic role because it is invasive and is associated with risk of complications, hence it is reserved for therapeutic procedures. Magnetic resonance cholangiography and portovenography is a noninvasive and comprehensive imaging technique, and is the modality of choice for mapping of the biliary and vascular abnormalities in these patients. PCC is a progressive condition and symptoms develop late in the course of portal hypertension only in patients with severe or advanced changes of cholangiopathy. Asymptomatic patients with PCC do not require any treatment. Treatment of symptomatic PCC can be approached in a phased manner, coping first with biliary clearance by nasobiliary or biliary stent placement for acute cholangitis and endoscopic biliary sphincterotomy for biliary stone removal; second, with portal decompression by creating portosystemic shunt; and third, with persistent biliary obstruction by performing second-stage biliary drainage surgery such as hepaticojejunostomy or choledochoduodenostomy. Patients with symptomatic PCC have good prognosis after successful endoscopic biliary drainage and after successful shunt surgery. ( J CLIN EXP HEPATOL 2014;4:S2-S14)

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Bile Duct Varices

Cited by 34 publications

References 8 publications

Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case

Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case

Liver transplantation in patients with portal vein thrombosis

Portal Cavernoma Cholangiopathy: Consensus Statement of a Working Party of the Indian National Association for Study of the Liver

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