Preview

Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery

Advanced search

Refractory ascites of complex genesis in patients with a severe combined form of extrahepatic portal hypertension

https://doi.org/10.16931/1995-5464.2022-1-87-93

Abstract

This study demonstrates a successful clinical outcome in a female patient with severe refractory ascites associated with a complex combined form of extrahepatic portal hypertension. The study emphasizes the need and particular importance of comprehensive diagnostics and assessment of the angioarchitectonics in the portal vein system, thorough study of the porto–hepatic circulation and central hemodynamics, as well as of other major homeokinesis disorders. Understanding the pathogenesis of the disease allows for the development of a therapeutic plan with a strictly personalized approach toward the selection and staging of various surgical interventions.

About the Authors

G. V. Manukyan
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Garik V. Manukyan – Doct. of Sci. (Med.), Head of the Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



R. A. Musin
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Rustam A. Musin – Cand. of Sci. (Med.), Senior Researcher, Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



V. M. Lebezev
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Victor M. Lebezev – Doct. of Sci. (Med.), Professor, Chief Researcher, Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



S. B. Zhigalova
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Svetlana B. Zhigalova – Doct. of Sci. (Med.), Leading Researcher, Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



E. A. Kitsenko
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Evgeniy A. Kitsenko – Doct. of Sci. (Med.), Leading Researcher, Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



D. V. Burenchev
A.K. Eramishantsev City Clinical Hospital
Russian Federation

Dmitry V. Burenchev – Doct. of Sci. (Med.), Head of the Department of X-ray and Radioisotope Research Methods

15, Lenskaya str., 129327, Moscow



V. A. Cherkasov
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Valery A. Cherkasov – Cand. of Sci. (Med.), Senior Researcher, Department of X-ray Surgical Methods of Diagnosis and Treatment

23, Kashirskoye shosse, Moscow, 115478



S. A. Rizaeva
Laboratory of Emergency Surgery and Portal Hypertension, Acad. B.V. Petrovsky National Research Center of Surgery
Russian Federation

Saida A. Rizaeva – post-graduate student of the Laboratory of Emergency Surgery and Portal Hypertension

2, Abrikosovsky lane, Moscow, 119991



References

1. Bashyam M., Lepore M., Harbord M. Management of cirrhotic ascites. Br. J. Hosp. Med. 2015; 76 (2): 28–32. https://doi.org/10.12968/hmed.2015.76.2.C28

2. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J. Hepatol. 2010; 53 (3): 397–417. https://doi.org/10.1016/j.jhep.2010.05.004

3. KASL clinical practice guidelines for liver cirrhosis: ascites and related complications. Clin. Mol. Hepatic. 2018; 24 (3): 230–277. https://doi.org/10.3350/cmh.2018.1005.

4. Fandeev E.E., Lyubivy E.D., Gonsalves Gonsalez D., Sysoeva E.P., Kitsenko E.A. Extrahepatic portal hypertension and portal vein thrombosis (review). Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (1): 45–58. https://doi.org/10.16931/1995-5464.2015145-58 (In Russian)

5. Hernandez-Gea V., De Gottardi A., Leebeek F.W.G., Rautou P.E., Salem R., Garcia-Pagan J.C. Current knowledge in pathophisiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis. J. Hepatology. 2019; 71 (1): 175–199. https://doi.org/10.1016/j.jhep.2019.02.015

6. Shin N., Kim Y.H., Xu H., Zhang Q.Q., Colon Pons J.P., Kim D., Xu Y., Wu F.Y., Han S., Lee B.B., Li L.-S. Redefining Budd-Chiari syndrome: a systematic review. World J. Hepatol. 2016; 8 (16): 691–702. https://doi.org/10.4254/wjh.v8.i16.691

7. Spaander M.C., Van Buuren H.R., Hansen B.E., Janssen H.L. Ascites in patients with non-cirrhotic non-malignant extrahepatic portal vein thrombosis. Aliment. Pharmacol. Ther. 2010; 32 (4): 529–534. https://doi.org/10.1111/j.1365-2036.2007.03488.x

8. Amitrano L., Guardascione M.A., Scaglione M., Pezzullo L., Sangiuliano N., Armellino M.F., Manguso F., Margaglione M., Ames P.R.J., Iannaccone L., Grandone E., Romano L., Balzano A. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am. J. Gastroenterol. 2007; 102 (11): 2464–2470. https://doi.org/10.1111/j.1572-0241.2007.01477.x

9. Spaander M.C., Van Buuren H.R., Janssen H.L. Non-cirrhotic non-malignant portal vein thrombosis: a review on management of non-cirrhotic non-malignant portal vein thrombosis and the concurrent portal hypertension compli cations in adults. Aliment. Pharmacol. Ther. 2007; 26 (2): 203–209. https://doi.org/10.1111/j.1365-2036.2007.03488.x

10. Yamazaki T., Ochi Y., Tanaka N., Watanabe T., Iwaya Y., Seki A., Hara E., Tanaka E., Watanabe T., Imai S., Hasebe O. Massive ascites caused by intra-pancreatic arterioportal fistula: a rare complication of chronic pancreаtitis. Clin. J. Gastroenterol. 2017; 10 (1): 73–78. https://doi.org/10.10007/s12328-016-0702-3

11. Popovic D. D.j., Spuran M., Davidovic L., Alempijevic M., Uglijesic M., Banzic I., Jadranin D., Kovacevic N., Perisic M., Colic M., Krstic M. Portal hypertension caused by postoperative superior mesenteric arteriovenous fistula. Vojnos. pregl. 202l; 69 (7): 623–626. PMID: 22838176

12. Garret H.E. Jr., Mack L. Coil embolization of spontaneous splenic arteriovenous fistula for treatment of portal hypertension. Am. J. Case Report. 2017; 18: 386–390. https://doi.org/10.12659/ajcr.901845

13. Grujic D., Knezevic A., Vojvodic S., Grujic B. Superior mesenteric arteriovenous presenting with massive lethal upper gastrointestinal bleeding 14 years after small bowel resection. Balcan Med. J. 2015; 32 (2): 214–217. https://doi.org/10.5152/balcаnmedj.2015.15608

14. Nie L., Luo X.F., Li X. Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis. World J. Gastroenterol. 2012; 18 (44): 6501–6503. https://doi.org/10.3748/wjg.v18.i44.6501

15. Zhao R., Lu J., Shi Y., Zhao H., Sheng Y. Current management of refractory ascites in patients with cirrhosis. J. Int. Med. Res. 2018; 46 (3): 1138–1145. https://doi.org/10.1177/0300060517735231

16. Adebayo D., Neong S.F., Wong F. Refractory ascites in liver cirrhosis. Am. J. Gastroenterol. 2019; 114 (1): 40–47. https://doi.org/10.1038/s41395-018-0185-6

17. Correa-Martin L., Castellanos G., Garsia-Lindo M., DiazGuemes I., Pinero A., Sanchez-Margallo F.M. Intra-abdominal hypertension: effects on the splanchnic circulation. Preliminary study in a model of ascites. Gastroenterol. Hepatol. 2014; 37 (2): 51–57. https://doi.org/10.1016/j.gastrohep.2013.08.002

18. Rogers W.K., Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018; 153 (1): 238–250. https://doi.org/10.1016/chest.2017.07.023

19. Manukyan G.V., Scherzinger A.G. Differentiated surgical treatment of portal hypertension and its complications in patients with liver cirrhosis. Part I. Assessment of diseases severity and choice of surgical intervention. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (1): 14–23. https://doi.org/10.16931/1995-5464.2015114-23 (In Russian)


Supplementary files

1. КТ-ангиография с 3D-реконструкцией сосудов
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
2. Целиакография. Определяются коллатерали от левой желудочной артерии к дистальной части селезеночной артерии
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
3. Заполнение дистальной части селезеночной артерии через множественные коллатерали при контрастировании а. gastroduodenalis
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
4. Стентирование нижней полой вены и правой печеночной вены.
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
5. Визуализация эндоваскулярного вмешательства при КТ-ангиографии с 3D-реконструкции сосудов
Subject
Type Исследовательские инструменты
View (734KB)    
Indexing metadata ▾
6. Выделение поджелудочной железы с конгломератом, образованным кистой, артерии-венозным соустьем и аневризмой селезеночной вены. Перевязка селезеночной артерии дистальнее окклюдера
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
7. Ложе удаленного конгломерата и дистального отдела поджелудочной железы. Обнаружение гипертрофированной добавочной селезенки.
Subject
Type Исследовательские инструменты
View (1MB)    
Indexing metadata ▾
8. Макропрепарат: киста поджелудочной железы с аневризмой культи селезеночной вены, частично заполненной пристеночным тромбом. Артерио-венозная фистула.
Subject
Type Исследовательские инструменты
View (824KB)    
Indexing metadata ▾
9. Фото больной через год после операции
Subject
Type Исследовательские инструменты
View (770KB)    
Indexing metadata ▾

Review

For citations:


Manukyan G.V., Musin R.A., Lebezev V.M., Zhigalova S.B., Kitsenko E.A., Burenchev D.V., Cherkasov V.A., Rizaeva S.A. Refractory ascites of complex genesis in patients with a severe combined form of extrahepatic portal hypertension. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2022;27(1):87-93. (In Russ.) https://doi.org/10.16931/1995-5464.2022-1-87-93

Views: 571


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1995-5464 (Print)
ISSN 2408-9524 (Online)