1/5. Massive splenic infarction in cirrhosis: report of a case with spontaneous disappearance of hypersplenism.A cirrhotic patient with massive splenic infarction is described. Celiac angiography showed normally opacified splenic artery and vein and a markedly enlarged spleen with large avascular zones. splenic infarction was associated with the spontaneous disappearance of a syndrome of hypersplenism. The spleen was surgically removed. Histological examination showed multiple thromboses of the small arterial and venous vessels. The cause of this infarct remained unclear.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy.A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. Endovascular treatment of a large fusiform splenic artery aneurysm with a coaxial technique using a 5-f balloon catheter and a microcatheter.A coaxial technique was introduced for successful embolization of a large fusiform splenic artery aneurysm in a vessel with a large caliber and a great degree of tortuosity. A standard 5-F angioplasty catheter was placed at the immediate afferent artery for occlusion of arterial inflow into the aneurysm, thereby preventing intraaneurysmal hypertension during embolization of the efferent segment. This was followed by coaxial microcatheterization of the immediate efferent segment for coil embolization, and then embolization of the afferent segment. It is postulated that this approach may improve the safety of embolization of large aneurysms with unfavorable morphology by decreasing the pressure on the aneurysm just after closure of the efferent segment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. Computed tomography follow-up of nonsurgical treatment for hypersplenism.For the treatment of hypersplenism, transcatheter embolization of the splenic artery and collateral vessels is an alternative to splenectomy, notably in high-risk or immunosuppressed patients. After arterial occlusion and thrombosis, follow-up computed tomography scans depict progressive changes in the extent and appearance of splenic infarcts, such that these changes correlate with improved platelet counts. Computed tomography thus performs the unique role of identifying specific patterns of infarction and also differentiating internal defects, such as suppurative, gaseous, or liquefaction necrosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |