Published online Oct 28, 2013. doi: 10.4329/wjr.v5.i10.381
Revised: September 2, 2013
Accepted: October 16, 2013
Published online: October 28, 2013
Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma. Traditionally, severe portal bleeding in this setting has been controlled by surgical techniques such as packing, ligation, and venorrhaphy. The presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to control. This case series describes the use of indirect carbon dioxide portography to identify portal hemorrhage. Furthermore, these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.
Core tip: The significance of bleeding from a portal venous origin following blunt hepatic trauma in the setting of portal hypertension, the potential role of indirect carbon dioxide venogram in identifying massive portal hemorrhage, and the use of a multiphase computed tomography of the liver in a trauma case with suspected internal bleeding and known portal hypertension are discussed. These cases illustrate attempted endovascular treatment of portal vein injury utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other. Further research is needed to elucidate outcomes of portal interventions in the setting of coexisting portal hypertension and hemorrhage.