{"title":"Endoscopic Removal of Pedunculated Leiomyoma of the Sigmoid Colon.","authors":"Harunobu Sato, Yoshihisa Mizuno, Tetsuya Tsukamoto, Tomoaki Ichikawa, Yoshihito Kotani, Katsuyuki Honda, Makoto Kuroda","doi":"10.1159/000368791","DOIUrl":"https://doi.org/10.1159/000368791","url":null,"abstract":"<p><strong>Background: </strong>The large bowel is a rare site for leiomyomas. Furthermore, a colonic pedunculated leiomyoma is very rare. Complete endoscopic removal of a colonic leiomyoma can be problematic because of its submucosal origin.</p><p><strong>Case report: </strong>We report a colonic pedunculated leiomyoma that was removed by endoscopic polypectomy without complications. A 74-year-old man was referred to our hospital because of constipation. Colonoscopy demonstrated a 1-cm pedunculated polyp that was connected to a minute stalk within the sigmoid colon. It was removed by snare polypectomy. Histopathological examination demonstrated normal mucosa overlying a well-circumscribed proliferation of eosinophilic spindle cells arising in association with the muscularis mucosae. Immunohistological findings were positive for desmin and smooth muscle actin. The polyp was diagnosed as a leiomyoma. More than 9 months later, the patient remains well, with no further symptoms.</p><p><strong>Conclusion: </strong>For small, pedunculated leiomyomas, endoscopic snare polypectomy is thought to be a useful approach for both treatment and diagnosis.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"427-9"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiological Diagnosis of Portal/Mesenteric Vein Occlusion.","authors":"Karlheinz Hauenstein, Yan Li","doi":"10.1159/000370055","DOIUrl":"https://doi.org/10.1159/000370055","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>Review of the literature.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"382-7"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000370055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of Portal/Mesenteric Vein Thrombosis.","authors":"Jörg C Kalff, Robert Thimme","doi":"10.1159/000370139","DOIUrl":"https://doi.org/10.1159/000370139","url":null,"abstract":"Portal vein thrombosis (PVT)/mesenteric vein thrombosis (MVT) is a rare but clinically relevant and important vascular disorder. The underlying causes of PVT/MVT are often multifactorial and include inherited thrombophilias, malignancies, liver cirrhosis, infections, or other processes localized to the epigastrium and hepatobiliary system. The three main categorical groups include malignant, cirrhotic, and non-malignant, non-cirrhotic PVT. Not only the etiology but also the site of thrombosis, its extension, and the natural course (progressive or self-resolving) determine the clinical presentation, the complications, and also the available treatment algorithms. Despite its high clinical relevance and possible deleterious clinical course, little information is currently available about optimal therapy strategies, and guidelines are not available. For this special issue, we have chosen a group of leading experts regarding the diagnosis and treatment of PVT/MVT to give important insights into its etiology, diagnosis, complications, and therapeutic options. Due to the fact that randomized studies including large patient cohorts are not available, we have selected experts from different specialties to state their point of view based on the literature as well as personal experience. Trebicka and Strassburg [1] summarize current concepts on etiologies, risk factors, and complications of this heterogeneous condition in adults. The diagnosis is based on imaging. The value and relevance of different methods, such as ultrasound, computed tomography, and magnetic resonance imaging, are summarized by Hauenstein and Li [2]. Nonsurgical therapeutic options in PVT may differ and have to consider the etiology, e.g. the presence of infection or tumors. The according therapy algorithms are summarized by Schultheiss et al. [3]. The article by Lang et al. [4] points out the interdisciplinary approach that is required to select an optimal individual therapy for a given patient based on clinical presentation, underlying diseases, extension of thrombosis, and the patient's comorbidities. A particular focus is therefore put on the surgical therapeutic options. A specific clinical challenge is a PVT in patients with liver cirrhosis. Rossle et al. [5] suggest therapy algorithms favoring TIPS (transjugular intrahepatic portosystemic shunt) as a first-line treatment for these patients. These algorithms are based on studies published in the last 10 years and on the clinical experiences of the authors. Portal hypertension is a major complication of PVT. Thus, in a final review article, Glowka et al. [6] summarize the clinical management of chronic portal hypertension with a specific focus on surgical therapeutic options. Finally, clinically relevant but also controversial aspects in the management of PVT are highlighted in the discussion chaired by Sauerbruch (with the participants Hopt, Neeff, Potzsch, Rossle, and Valla) [7]. \u0000 \u0000In sum, we hope that these articles written by ","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"373-4"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000370139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Etiology and Complications of Portal Vein Thrombosis.","authors":"Jonel Trebicka, Christian P Strassburg","doi":"10.1159/000369987","DOIUrl":"10.1159/000369987","url":null,"abstract":"<p><strong>Background: </strong>Portal venous occlusion represents a disorder with considerable clinical relevance. The underlying causes of portal vein thrombosis (PVT) are frequently multifactorial and include malignancies, progressive chronic liver diseases, processes localized to the epigastrium and hepatobiliary system, and acquired as well as inherited thrombophilia. The three main categorical groups are malignant thrombosis, cirrhotic PVT, and non-malignant, non-cirrhotic PVT.</p><p><strong>Methods: </strong>Review of the literature.</p><p><strong>Results: </strong>The site, the extent, its chronicity, and the course of thromboses characterize a relatively heterogeneous clinical presentation and the ensuing complications in affected patients. While the occlusion of the extrahepatic portal and splenic vein likely provokes mainly complications related to portal hypertension, mesenteric venous obstruction shows a high rate of complications and mortality due to intestinal infarction. Especially in patients with liver cirrhosis, special care is warranted with regard to PVTs due to their pathogenetic role and influence on patient survival.</p><p><strong>Conclusion: </strong>This article aims to summarize the current opinion on etiologies, risk factors, and complications of this heterogeneous condition in adults.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"375-80"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View.","authors":"Martin Rössle, Birke Bausch, Christoph Klinger","doi":"10.1159/000370053","DOIUrl":"https://doi.org/10.1159/000370053","url":null,"abstract":"<p><strong>Background: </strong>Treatment of non-malignant portal vein thrombosis (PVT) in patients with cirrhosis has been neglected in the past because of the fear of bleeding complications when using anticoagulation and due to the technical difficulties associated with the implantation of the transjugular intrahepatic portosystemic shunt (TIPS). However, PVT has a negative impact on outcome and compromises liver transplantation, warranting treatment by using anticoagulation and TIPS.</p><p><strong>Methods: </strong>This review considers studies on the treatment of PVT in cirrhosis published in the last 10 years. Unfortunately, many of these studies are limited by their retrospective design and a small sample size.</p><p><strong>Results: </strong>Anticoagulation using low-molecular-weight heparin (LMWH) or vitamin K antagonists is effective in the treatment of patients with limited and recent PVT, resulting in a recanalization in up to 50% of the patients. TIPS (plus local measures) results in a recanalization of up to 100% and reduces the rebleeding rate considerably in patients with recent or chronic PVT.</p><p><strong>Conclusion: </strong>Based on the presently limited knowledge, a therapy algorithm is suggested favouring the TIPS as a first-line treatment for PVT in patients with symptomatic portal hypertension. Patients with thus far asymptomatic portal hypertension may first receive anticoagulation, preferably using LMWH. If these patients have a condition where anticoagulation is not promising (complete, extended, chronic PVT) or ineffective, or if they are candidates for liver transplantation, the TIPS may be implanted without delay.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"401-8"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000370053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transanal Tube as a Means of Prevention of Anastomotic Leakage after Rectal Cancer Surgery.","authors":"Zuzana Adamova","doi":"10.1159/000369569","DOIUrl":"https://doi.org/10.1159/000369569","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leaks after low anterior resection for rectal cancer remain the most feared complication. The aim of our study was to investigate whether the use of a transanal tube could reduce the leakage rate after this surgical procedure.</p><p><strong>Methods: </strong>This is a retrospective analysis of a single-institution experience. The study includes 66 patients who underwent low anterior resection for rectal cancer without stoma creation between January 2008 and June 2013. Patients were divided into two groups, i.e. those with a transanal drainage tube (TT; n = 9) and those without tube (NTT; n = 57), and evaluated for clinically evident anastomotic leakage and postoperative complications.</p><p><strong>Results: </strong>The postoperative anastomotic leakage appeared in 5 patients (9%) in the NTT group while no single case was observed within the TT group. Despite the disadvantageous background in the TT group (a transanal stent was used in the most high-risk patients), these patients had no postoperative complications. In the NTT group, 23% had some kind of postoperative complications, and 5% died. The difference between the two groups is not significant.</p><p><strong>Conclusions: </strong>Our study showed that the use of a transanal tube in low anterior resection for rectal cancer could potentially be a simple and effective method of reducing anastomotic leakage. In order to prove our observations, larger prospective randomized studies should be performed.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"422-6"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000369569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Schultheiß, Dominik Bettinger, Robert Thimme
{"title":"Nonsurgical Therapeutic Options in Portal Vein Thrombosis.","authors":"Michael Schultheiß, Dominik Bettinger, Robert Thimme","doi":"10.1159/000369848","DOIUrl":"https://doi.org/10.1159/000369848","url":null,"abstract":"<p><strong>Background: </strong>Portal vein thrombosis (PVT) is a rare but severe vascular disorder with an acute and a chronic course. Most patients have underlying liver cirrhosis; furthermore, thrombophilia is an important risk factor. However, idiopathic forms are also known.</p><p><strong>Methods: </strong>This review discusses nonsurgical treatment options in PVT.</p><p><strong>Results and conclusion: </strong>Therapy of acute PVT is based on anticoagulation with heparin that is switched to oral anticoagulants, if applicable. Catheter-guided invasive therapy should be considered; however, patients with liver cirrhosis should be screened for portal hypertension before anticoagulation is mandatory. Therapy of chronic PVT is discussed controversially; therefore, a strict patient selection and an individual therapeutic decision are warranted depending on the etiology of PVT. Special forms of PVT including septic and malignant thrombosis as well as PVT in patients waiting for liver transplantation require particular therapy algorithms.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"388-92"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000369848","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Management of Chronic Portal/Mesenteric Vein Thrombosis: The Surgeon's Point of View.","authors":"Tim R Glowka, Jörg C Kalff, Nico Schäfer","doi":"10.1159/000369575","DOIUrl":"https://doi.org/10.1159/000369575","url":null,"abstract":"<p><strong>Background: </strong>Bleeding from esophageal varices is a life-threatening complication of chronic portal hypertension (PH), occuring in 15% of patients with a mortality rate between 20 and 35%.</p><p><strong>Methods: </strong>Based on a literature review and personal experience in the therapy of PH, we recommend a therapy strategy for the secondary prophylaxis of variceal bleeding in PH.</p><p><strong>Results: </strong>The main causes for PH in western countries are alcoholic/viral liver cirrhosis and extrahepatic portal/mesenteric vein occlusion, mainly caused by myeloproliferative neoplasms or hypercoagulability syndromes. The primary therapy is medical; however, when recurrent bleeding occurs, a definitive therapy is required. In the case of parenchymal decompensation, liver transplantation is the causal therapy, but in case of good hepatic reserve or without underlying liver disease, a portal decompressive therapy is necessary. Transjugular intrahepatic portosystemic shunt has achieved a widespread acceptance, although evidence is comparable with or better for surgical shunting procedures in patients with good liver function. The type of surgical shunt should be chosen depending on the patent veins of the portovenous system and the personal expertise.</p><p><strong>Conclusion: </strong>The therapy decision should be based on liver function, morphology of the portovenous system, and imminent liver transplantation and should be made by an interdisciplinary team of gastroenterologists, interventional radiologists, and visceral surgeons.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"409-15"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000369575","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sven A Lang, Martin Loss, Walter A Wohlgemuth, Hans J Schlitt
{"title":"Clinical Management of Acute Portal/Mesenteric Vein Thrombosis.","authors":"Sven A Lang, Martin Loss, Walter A Wohlgemuth, Hans J Schlitt","doi":"10.1159/000369896","DOIUrl":"https://doi.org/10.1159/000369896","url":null,"abstract":"<p><strong>Background: </strong>Acute thrombosis of the portal vein (PV) and/or the mesenteric vein (MV) is a rare but potentially life-threatening disease. A multitude of risk factors for acute portal vein thrombosis (PVT)/mesenteric vein thrombosis (MVT) have been identified, including liver cirrhosis, malignancy, coagulation disorders, intra-abdominal infection/inflammation, and postoperative condition.</p><p><strong>Methods: </strong>This article analyses the treatment options for acute PVT/MVT.</p><p><strong>Results: </strong>Initially, the clinical management should identify patients with an intra-abdominal focus requiring immediate surgical intervention (e.g. bowel ischaemia). Subsequently, emphasis is placed on the recanalization of the PV/MV or at least the prevention of thrombus extension to avoid long-term complications of portal hypertension. Several therapeutic options are currently available, including anticoagulation therapy, local/systemic thrombolysis, interventional or surgical thrombectomy, and a combination of these procedures. Due to the lack of prospective randomized studies, a comparison between these therapeutic approaches regarding the efficacy of PV/MV recanalization is difficult, if not impossible.</p><p><strong>Conclusion: </strong>In patients with acute PVT/MVT, an individualized treatment based on the clinical presentation, the underlying disease, the extent of the thrombosis, and the patients' comorbidities is mandatory. Therefore, these patients should be considered for an interdisciplinary therapy in specialized centres with the option to utilise all therapeutic approaches currently available.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 6","pages":"394-400"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000369896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33999697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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