Careful observation of hepatic portal venous gas following esophageal variceal band ligation

Ahmed, Kashif; Atiq, Mehnaz; Richer, Edward J.; Neff, G; Kemmer, Nyingi; Safdar, Kamran

doi:10.1055/s-2007-966850

“…Long-term PH causes splanchnic congestion and intractable ascites. Splanchnic congestion results in breakdown of the enteric barrier [66] , and portal venous gas and/ or abdominal compartment syndrome may be temporally observed [66][67][68] . Induction of drugs with fibrolytic activity (not heparin, but urokinase and warfarin) should be initiated without hesitation based on the endothelial damage in patients with LC, although heparin induction may be effective from the viewpoint of thromboprophylaxis [69] .…”

Section: Management Of Lt Recipients With Advanced Lcmentioning

confidence: 99%

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hori

¹

,

Ogura

²

,

Onishi

³

et al. 2016

WJH

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Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination Hori T et al . Peculiar hemodynamics in advanced cirrhosis constant (k ICG) in the well-preserved allograft. The k ICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

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“…Only a small fraction of cases are attributed to radiologic and endoscopic procedures. Of these, HPVG has been reported following EGD in patients with a gastric ulcer 3 and duodenal tumor, 4 after corrosive acid ingestion, 5 following esophageal variceal sclerotherapy and banding, 6 after percutaneous endoscopic gastrostomy, and after ERCP. 5 …”

Section: Discussionmentioning

confidence: 99%

Hepatic Portal Venous Gas: An Unusual Complication Following Upper Endoscopy and Dilation

Seeger¹,

Achem²

2014

ACG Case Reports Journal

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Hepatic portal venous gas (HPVG), a rare condition in which gas accumulates in the portal venous circulation, is often associated with a significant underlying pathology, such as intestinal ischemia, sepsis, and trauma. HPVG after endoscopy or dilation is an unusual complication. We report a case of HPVG following upper endoscopy and dilation for an esophageal stricture in a 34-year-old patient with eosinophilic esophagitis (EoE). The patient was treated conservatively, and his symptoms resolved. Follow-up computed tomography (CT) scan showed resolution of HPVG. This case highlights a rare and potentially ominous complication of upper endoscopy and dilation and underscores the role of conservative management.

show abstract

“…Only a small fraction of cases are attributed to radiologic and endoscopic procedures. Of these, HPVG has been reported following EGD in patients with a gastric ulcer 3 and duodenal tumor, 4 after corrosive acid ingestion, 5 following esophageal variceal sclerotherapy and banding, 6 after percutaneous endoscopic gastrostomy, and after ERCP. 5 HPVG is best diagnosed with CT, where it appears as tubular areas of decreased attenuation in the liver.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Portal Venous Gas: An Unusual Complication Following Upper Endoscopy and Dilation

Seeger¹,

Achem²

2013

American Journal of Gastroenterology

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Hepatic portal venous gas (HPVG), a rare condition in which gas accumulates in the portal venous circulation, is often associated with a significant underlying pathology, such as intestinal ischemia, sepsis, and trauma. HPVG after endoscopy or dilation is an unusual complication. We report a case of HPVG following upper endoscopy and dilation for an esophageal stricture in a 34-year-old patient with eosinophilic esophagitis (EoE). The patient was treated conservatively, and his symptoms resolved. Follow-up computed tomography (CT) scan showed resolution of HPVG. This case highlights a rare and potentially ominous complication of upper endoscopy and dilation and underscores the role of conservative management.

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Careful observation of hepatic portal venous gas following esophageal variceal band ligation

Cited by 9 publications

References 2 publications

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hepatic Portal Venous Gas: An Unusual Complication Following Upper Endoscopy and Dilation

Hepatic Portal Venous Gas: An Unusual Complication Following Upper Endoscopy and Dilation

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