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2014 ; 30
(6
): 382-7
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Radiological Diagnosis of Portal/Mesenteric Vein Occlusion
#MMPMID26288605
Hauenstein K
; Li Y
Viszeralmedizin
2014[Dec]; 30
(6
): 382-7
PMID26288605
show ga
BACKGROUND: In contrast to an acute occlusion of the visceral arteries, which is
the most important differential diagnosis for an occlusion of the portal venous
system and which poses a highly dangerous situation ending in gangrene of the
bowel wall, the symptoms of an acute occlusion of the portal venous system are
quite unspecific. To rule out an acute arterial occlusion, diagnostic evaluation
has to be carried out quickly in order to decide on the necessity of therapeutic
steps concerning a recanalization of the occluded vessels. Only few therapeutic
options are available to recanalize and remodel the portal venous system,
depending on the underlying disease, the age of the occlusion, its extension, and
the effect on the bowel wall, stomach, spleen, and abdominal wall. Moreover, the
efficacy of recanalization procedures mainly depends on the formation and number
of collateral venous blood supply, its degree, and the anatomic structure.
Possible complications of portal hypertension like varices, gastrointestinal
vasculopathy, ascites, and splenomegaly also influence the success of
recanalization procedures. Only in cases of acute thrombotic occlusion systemic
lytic therapy promises to be successful. Therefore, other options such as
transjugular intrahepatic recanalization, e.g. by means of the TIPS (transjugular
intrahepatic portosystemic shunt) procedure, have to be evaluated. METHODS:
Review of the literature. RESULTS: Noninvasive methods such as ultrasound (US),
computed tomography, and especially magnetic resonance imaging (MRI) allow the
evaluation of therapeutic options as well as their success, the feasibility of
technical procedures, the detection of possible risks, and a calculation of risks
and benefits. CONCLUSION: In order to arrive at the correct therapeutic decision,
a combination of MRI and US methods combined with color Doppler guarantee the
most efficient diagnostic results in cases with acute or chronic occlusions of
the portal venous system.
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