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Liver resection for the treatment of a congenital intrahepatic portosystemic venous shunt

Hepatobiliary & Pancreatic Diseases International 2016年第3期15卷 329-333页

作者： michail papamichail amir ali alberto quaglia john karani nigel heaton Department of Hepatobiliary Pancreatic Surgery First Affiliated Hospital:King's Healthcare PartnersKing's College Hos-pital FT NHS Trust Institute of Liver Studies Denmark HillLondon SE5 9RSUK

Intrahepatic portosystemic shtmts （IPSS） are rare congenital anomalies arising from disordered portal vein em- bryogenesis. It has been described in both children and adults and may be asymptomatic or be associated with a variety of neurophysiological and pulmonary complications. When rec- ognized, early intervention to occlude the shunt will reverse the associated complications. Literature review reports of surgical and radiological occlusion of the shunt, but due to its rarity, a standard therapeutic protocol has not been established. A case of a 38-year-old woman with abdominal pain and low grade encephalopathy, diagnosed with an IPSS and treated by right hepatectomy was reported.

关键词： intrahepatic portosystemic shunt liver resection

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Congenital extrahepatic portosystemic shunt complicated by the development of hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2015年第5期14卷 552-557页

作者： Ruchi Sharma Abid Suddle Alberto Quaglia Praveen Peddu john karani Thomas Satyadas Institute of Liver Studies King's College Hospital Department of Radiology King's College Hospital Central Manchester University Hospital Manchester Royal Infirmary

Congenital extrahepatic portosystemic shunt,also known as Abernethy malformation, is a rare congenital malformation. It causes shunting of blood through a communication between the portal and systemic veins such as a patent ductus venous. We report 3 cases of Abernethy malformation complicated by the development of hepatocellular carcinoma. Additionally, we comprehensively reviewed all previously reported cases and highlighted common features that may help in early diagnosis and appropriate *** with Abernethy malformation may have an increased propensity to develop hepatocellular carcinoma. All 5 previously reported cases, plus the three of our patients, have a type 1（complete） shunt suggesting a role for absent portal blood flow in the pathogenesis of hepatocellular carcinoma. Congenital extrahepatic portosystemic shunt should be sought for in cases with raised serum ammonia, hepatic encephalopathy or hepatocellular carcinoma in the absence of cirrhosis.

关键词： Abernethy malformation congenital extrahepatic portosystemic shunt congenital absence of portal vein patent ductus venosus hepatocellular carcinoma

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Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 634-638页

作者： Harsheet Sethi Praveen Peddu Andreas Prachalias Pauline Kane john karani Mohamed Rela Nigel Heaton Department of Hepatobiliary Surgery Institute ofLiver Studies Kings College London School of Medicine at Kings College Hospital Department of Hepatobiliaryand Interventional Radiology Institute ofLiver StudiesKings College London School of Medicine at Kings College Hospital

BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June *** visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of *** was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one *** 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 *** patient developed spontaneous thrombosis of the *** patients had effective coil embolization of the *** patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis *** were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their ***-existent portal hypertension and sepsis increase the risk of *** and selective coil embolization is a safe and effective way to arrest the hemorrhage.

关键词： pseudoaneurysm embolization acute pancreatitis chronic pancreatitis vascular complications

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