Kono Mei, Akahane Masaaki, Yoshioka Naoki, Hirano Yuichiro, Ohizumi Yuji, Fukuda Issei, Fujiwara Shin, Ishiguro Taiga, Kiryu Shigeru
Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, 286-8520, Chiba, Japan.
Surg Radiol Anat. 2025 Jan 28;47(1):63. doi: 10.1007/s00276-025-03576-1.
We present the case of a rare extrahepatic portocaval shunt that resulted in communication of the portal vein and the inferior vena cava (IVC) at the level between two right renal veins that was incidentally diagnosed with contrast-enhanced computed tomography (CECT) in an asymptomatic patient.
A woman in her sixties with abdominal pain and diarrhea of unclear origin underwent exploratory abdominal CECT.
The CECT incidentally revealed an extrahepatic portocaval shunt, whereby a vessel arising from the portal vein superior to the confluence of the superior mesenteric and splenic veins drained into the posterior aspect of the IVC between two right renal veins.
The identified vessel was likely a remnant communication between the supra-subcardinal anastomosis and the primitive portal vein. This type of portocaval shunt is rare; although there are no reports of its asymptomatic presence in an adult, recognition thereof may help to identify the cause of symptoms related to hepatic encephalopathy or liver dysfunction. Such a shunt may also provide a minimally invasive approach to the portal vein in procedures that typically rely on access via the transhepatic route.
我们报告一例罕见的肝外门腔分流病例，该分流导致门静脉与下腔静脉（IVC）在两条右肾静脉之间的水平相通，此病例在一名无症状患者的增强计算机断层扫描（CECT）检查中被偶然发现。
一名60多岁原因不明的腹痛和腹泻女性接受了腹部探查CECT检查。
CECT偶然发现肝外门腔分流，即一条起源于门静脉、位于肠系膜上静脉和脾静脉汇合处上方的血管汇入两条右肾静脉之间的IVC后壁。
所发现的血管可能是上主静脉吻合与原始门静脉之间的残余交通支。这种类型的门腔分流很少见；虽然尚无成人无症状存在这种分流的报道，但认识到这一点可能有助于确定与肝性脑病或肝功能障碍相关症状的病因。这种分流在通常依赖经肝途径进入门静脉的手术中，也可能提供一种微创的门静脉入路。
