Echo-Doppler Evaluation of Reverse Flow Sign in the Intrahepatic Portal Branches After Surgery

Abstract

ObjectiveThe authors evaluated the clinical significance of the development of reversed portal flow after abdominal surgery other than portosystemic shunt procedure. Summary Background DataThere have been several reports in regard to reversed portal flow demonstrated by pulsed Doppler ultrasonography, most of which were related to portal hypertension. To the authors' knowledge, this is the first report in which reversed portal flow also is present in patients who have undergone abdominal surgery other than portosystemic shunt procedure. MethodsPreoperative and postoperative pulsed Doppler ultrasonographic examinations were performed in 126 patients who underwent abdominal surgery. Postoperatively, the portal flow direction was assessed in the right portal branch or the umbilical portion of the left portal branch. ResultsOf the 126 patients, reversed portal flow developed in 10 after surgery; 9 of them died of liver failure. ConclusionsThe postoperative development of reversed portal flow is considered to have grave prognostic significance, indicating that the degree of postoperative liver damage is extremely critical.It is well known that portal flow direction can easily be altered when the gradient of portal venous pressure is reversed, because the portal venous system is a circulatory system without valves. There have been many reports ofhepatofugal flow in the portal vein under various conditions.11 1 In the course of our observations of postoperative changes in portal hemodynamics using pulsed Doppler ultrasonography, we encountered ten patients in whom the portal flow direction changed from hepatopetal to hepatofugal after abdominal surgery other than portosystemic shunt procedures. Critical liver dysfunction developed subsequently in all except one. As far as 370

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“…10 Nishihara et al 11 reported that the development of hepatofugal flow after general surgery indicated a poor prognosis. The reasons of the reversed portal flow are thought to be as follows:…”

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“…A few studies have reported the reversal of portal flow after abdominal surgery other than portosystemic shunt procedures 8. Nishihara et al6 reported the presence of hepatofugal flow in portal vein in the postoperative course of hepatopancreatic surgery. Of the ten patients in whom hepatofugal portal flow was observed by Nishihara et al6, nine died.…”

“…Nishihara et al6 reported the presence of hepatofugal flow in portal vein in the postoperative course of hepatopancreatic surgery. Of the ten patients in whom hepatofugal portal flow was observed by Nishihara et al6, nine died. The development of hepatofugal flow after surgery indicates a poor prognosis.…”

“…Most reports of hepatofugal portal flow have been in patients with cirrhosis3 or in those who have undergone portosystemic shunt procedures 4,5. There are few reports of hepatofugal portal flow after surgery other than portosystemic shunt procedures 6. In liver transplantation, although postoperative hepatofugal portal flow has been observed in patients with portal thrombosis or hepatic venous stenosis,7 there have been few reports of hepatofugal portal flow in patients with acute rejection.…”