Incidental Portal Vein Aneurysm Found in a Patient with a Diaphragmatic Hernia and Evolving Gastric Volvulus
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Rare and poorly described within the literature, a portal vein aneurysm (PVA) is defined as an abnormal vascular dilation of the portal vein exceeding 19 mm in patients with cirrhotic livers and 15 mm in patients with normal livers. Incidence has been estimated to be 0.06[percent] and fewer than 200 cases have been described in the literature1,4. We describe an incidental and asymptomatic PVA found in an 80-year-old Caucasian male presenting with evolving gastric volvulus in the context of a large diaphragmatic hernia. Computed tomography (CT) revealed displacement of abdominal contents and 37 mm aneurysm of the main portal vein (image 1,2). Because of the large size of our patients' malformation (37 mm), surgery was pursued in the form of aneurysmorrhaphy. There is a paucity of literature regarding the management of PVA - however the literature distinguishes between those with and without underlying portal hypertension. Notably, the patient was asymptomatic from this pathology and had no underlying portal hypertension. He was seen in an outpatient clinic two weeks after discharge and had fully recovered without any reported sequela or symptoms related to his vascular surgery.
Am J Hosp Med 2020 April;4(2):2020.015 https://doi.org/10.24150/ajhm/2020.015
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