Case Report
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World J Radiol. Oct 28, 2013; 5(10): 381-385
Published online Oct 28, 2013. doi: 10.4329/wjr.v5.i10.381
Endovascular interventions for traumatic portal venous hemorrhage complicated by portal hypertension
Dinesh Kumar Sundarakumar, Crysela Mirta Smith, Jorge Enrique Lopera, Matthew Kogut, Rajeev Suri
Dinesh Kumar Sundarakumar, Crysela Mirta Smith, Jorge Enrique Lopera, Rajeev Suri, Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, United States
Dinesh Kumar Sundarakumar, Matthew Kogut, Department of Radiology, University of Washington Medical Center, Seattle, WA 98195, United States
Author contributions: Sundarakumar DK and Smith CM made substantial contributions to conception and drafting the article; Lopera JE, Kogut M and Suri R revised it critically for important intellectual content, and approved the final version to be published.
Correspondence to: Dinesh Kumar Sundarakumar, Fellow, Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, NW011 Mailing Box 357115, Seattle, WA 98195, United States. dinkuaiims@gmail.com
Telephone: +1-206-7642149 Fax: +1-206-5986406
Received: July 6, 2013
Revised: September 2, 2013
Accepted: October 16, 2013
Published online: October 28, 2013
Abstract

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.

Keywords: Trauma, Portal vein, Portal hypertension, Transjugular Intrahepatic Portasystemic Shunt, Varix

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.