Abstract
Aneurysms in the portal venous system are relatively rare. We report the case of an extrahepatic portal venous aneurysm, detected incidentally by ultrasonography. The patient, a 75-year-old woman, was initially observed over 18 months, during which time, the aneurysm grew from 36 mm × 32 mm to 51 mm × 37 mm in size, without symptoms. Hemodynamic analysis employing computational flow dynamics technique showed obvious turbulence in the aneurysm, and the wall shear stress (WSS) against that part of the aneurysmal wall was greater than in other sites. To prevent complications such as spontaneous rupture and portal vein thrombosis, the aneurysm was resected, with reconstruction of the portal trunk. While careful follow-up is sufficient for most portal venous aneurysms, its enlargement could indicate possible spontaneous rupture. The increased WSS against part of the aneurysmal wall most likely accounts for the aneurysm enlargement in this case.
This is a preview of subscription content, log in via an institution to check access.
References
Koc Z, Oguzkurt L, Ulusan S. Portal venous system aneurysms: imaging, clinical findings, and a possible new etiologic factor. AJR. 2007;189:1023–30.
Brock PA, Jordan PH Jr, Barth MH, Rose AG. Portal vein aneurysm: a rare but important vascular condition. Surgery. 1997;121:105–8.
Barzilai R, Kleckner MS Jr. Hemocholecyst following ruptured aneurysm of portal vein; report of a case. AMA Arch Surg. 1956;72:725–7.
Thomas TV. Aneurysm of the portal vein: report of two cases, one resulting in thrombosis and spontaneous rupture. Surgery. 1967;61:550–5.
Shimoda M, Kubota K, Sakuma A, Hogami T, Yamaguchi H, Tagaya N. Intra-abdominal hemorrhage due to rupture of a splenic vein aneurysm: a case report. J Gastrointest Surg. 2003;7:683–6.
Iimuro Y, Saito S, Yamanaka J, Hirano T, Kuroda N, Okada T, et al. Computational flow dynamics simulation of portal branches is useful for analyzing the mechanism of non-uniform regional liver regeneration after surgical resection. Hepatology. 2007;46:429A.
Ma R, Balakrishnan A, See TC, Liau SS, Praseedom R, Jah A. Extra-hepatic portal vein aneurysm: a case report, overview of the literature and suggested management algorithm. Int J Surg Case Rep. 2012;3:555–8.
Gallego C, Velasco M, Marcuello P, Tejedor D, De Campo L, Friera A. Congenital and acquired anomalies of the portal venous system. Radiographics. 2002;22:141–59.
Lall C, Verma S, Gulati R, Bhargava P. Portal vein aneurysm presenting with obstructive jaundice. J Clin Imaging Sci. 2012;2:54.
Flis V, Gadzijev E. Reconstruction of the main portal vein for a large saccular aneurysm. HPB (Oxford). 2003;5:188–90.
Jin B, Sun Y, Li YQ, Zhao YG, Lai CS, Feng XS, et al. Extrahepatic portal vein aneurysm: two case reports of surgical intervention. World J Gastroenterol. 2005;11:2206–9.
Cho SW, Marsh JW, Fontes PA, Daily MF, Nalesnik M, Tublin M, et al. Extrahepatic portal vein aneurysm—report of six patients and review of the literature. J Gastrointest Surg. 2008;12:145–52.
Santana P, Jeffrey RB Jr, Bastidas A. Acute thrombosis of a giant portal venous aneurysm: value of color Doppler sonography. J Ultrasound Med. 2002;21:701–4.
Conflict of interest
Yuji Iimuro and his co-authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iimuro, Y., Suzumura, K., Ohashi, K. et al. Hemodynamic analysis and treatment of an enlarging extrahepatic portal aneurysm: report of a case. Surg Today 45, 383–389 (2015). https://doi.org/10.1007/s00595-014-0882-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-014-0882-8