Obstructive jaundice caused by cavernous transformation of the portal vein

Meredith, Hubert C.; Vujic, Ivan; Schabel, Stephen I.; O'Brien, Patrick

doi:10.1259/0007-1285-51-612-1011

Cited by 37 publications

(22 citation statements)

References 4 publications

(6 reference statements)

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“…1 Only sporadic reports appeared over the next few decades [7][8][9] illustrating the rarity of this condition in the West. Though surgical hazards posed by common bile duct (CBD) varices were recognized in the late 1970s, 10 it was the seminal paper by Webb and Sherlock 11 that focussed attention on this condition.…”

Section: Historical Perspective Nomenclature and Definitionmentioning

confidence: 99%

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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Section: Historical Perspective Nomenclature and Definitionmentioning

confidence: 99%

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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“…When feasible, venous occlusion should be remedied. The portal decompressive measures described above should relieve the venous dilatation and consequent obstructive jaundice if present, but reports are rare [107,108].…”

Section: Biliary Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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“…This fi nding has been described as a "solid, tumorlike cavernoma," occurring in some patients with PVT ( 14 ). The importance of this distinction is that varicoid PB may be reversible with decompression of the collateral veins, while the fi brotic type is not-especially in long-standing cases of PB in which fibrotic lesions seem to predominate (15)(16)(17)(18). We did not specifi cally note enhancing fi brotic lesions in our patients with extrahepatic PB and propose that the "fi xed" biliary obstruction may in fact be a result of chronic kinking of the extrahepatic bile duct by the pancreaticoduodenal veins, rather than ischemia or infl ammation produced by chronic hypertrophy of the…”

mentioning

confidence: 99%