Splanchnic Artery Aneurysms

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

Section: Splenic Artery Aneurysm Rupturementioning

confidence: 99%

Pregnancy with Portal Hypertension

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

“…The incidence of intra-abdominal visceral pseudoaneurysms is rare and has been reported to be less than 1% in postmortem studies [1,2]. They occur most commonly in the splenic artery (60%), hepatic artery (20%), superior mesenteric artery (5%), and celiac trunk (4%) [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…The signs and symptoms of aneurysms can often be non-specific, and early recognition is critical to prevent catastrophic bleeding [1][2][3]. We report a rare case of left gastric artery pseudoaneurysm in a middle aged male who presented with severe abdominal pain initially thought to be due to acute pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left gastric artery pseudoaneurysm as a sequelae of chronic pancreatitis: recognizing a life-threatening complication

Pattanshetty

Bhat

2014

Open Medicine

AbstractLeft gastric artery pseudoaneurysm is a rare but important life-threatening complication of chronic pancreatitis. We report a case of a 54-year-old male with chronic pancreatitis who presented with history of severe abdominal pain. Following an initial suspicion of acute pancreatitis, a computed tomography of abdomen was obtained that showed a large left gastric artery pseudoaneurysm (4×4 cm) with circumferential thrombosis. The patient then underwent successful angiographic coiling of the aneurysm, thus preventing a potentially life-threatening hemorrhage. In conclusion, in patients with a history of chronic pancreatitis who present with abdominal pain, a high index of suspicion should be maintained for alternate causes of abdominal pain such as visceral aneurysms involving left gastric artery. Early recognition is critical and consequences of missing these lesions can be catastrophic.

“…US is an excellent noninvasive method in the evaluation of the liver and porta hepatis for the presence of HAA and customary use of US has led to increased diagnosis of asymptomatic aneurysms. Moreover, the US has a low sensitivity for small aneurysms because identification may be compromised by overlying gas and obesity 10 . Spectral Doppler can aid in differentiating vascular from other types of masses and color Doppler shows arterial or turbulent flow in the lesion suggestive of it being a mass of vascular origin 11 .…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery aneurysm: incidental diagnosis with abdominal ultrasonography and treatment by coil embolization

et al. 2012

Hepatic artery aneurysm (HAA) was first reported at autopsy in 1809, represents one fifth of visceral aneurysms and the mortality from spontaneous rupture is high in most of cases. We are reporting a case of an asymptomatic 48-year-old woman with an extrahepatic HAA, diagnosed initially and incidentally with abdominal ultrasonography, confirmed by a three-dimensional contrast-enhanced magnetic resonance imaging and angiography. Endovascular treatment was considered feasible and was successfully treated with coil embolization.