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We report on a 28-year-old previously healthy patient with initially elevated temperature and cough and developing most severe epigastric pain and peritonism in the right upper abdomen. A "bedside" sonography revealed a portal vein thrombosis, the CT additionally partial thromboses of the vena lienalis, vena mesenterica superior. During the examination, a SARS-CoV-2 infection (IgM, IgG) was confirmed. Currently (pandemic), extrapulmonary thromboembolism must also be considered. For this purpose, sonography is the appropriate "search method" – it can be used from "head to toe", immediately and at the "bedside". [ABSTRACT FROM AUTHOR]

Hintergrund: Die Grenzbereiche der Lebertransplantation liegen vor allem in der Ausweitung der Indikation (hepatozelluläres Karzinom, [perihiläres] Cholangiokarzinom, Empfänger mit gravierenderen Nebendiagnosen bzw. „weichen" Kontraindikationen) und technisch anspruchsvollen Rekonstruktionsverfahren der vaskulären Strukturen (bei Portalvenenthrombose bzw. schwieriger arterieller Anschlussmöglichkeit) sowie einer Erweiterung des Spenderpools mit suboptimalen Organen (ältere Spender, steatotische Lebern).Methoden: Anhand persönlicher Erfahrungen im klinischen Alltag und entsprechender Literaturrecherche legen wir in diesem Artikel die aktuelle Situation dar.Ergebnisse: In Deutschland zeigt sich eine deutliche Abnahme des 1‑Jahres-Überlebens. Der Anteil an „schwer vermittelbaren" („marginalen") Spenderorganen verhält sich dabei reziprok zum massiv erniedrigten Spenderaufkommen und parallel zur steigenden Wartelistenmortalität (WL). Gleichzeitig nimmt der Anteil an stationären WL-Patienten mit Mehrorganversagen zu.Schlussfolgerung: Eine ergebnisorientierte und -kontrollierte Lebertransplantation erlaubt heutzutage kaum noch ein Vordringen in ehemalige Grenzbereiche. Solange sich die aktuellen Bedingungen nicht ändern, wird ein Verschieben der Grenzen des chirurgisch Machbaren kaum möglich sein. Vielmehr kann in der aktuellen Situation durch restriktivere Indikationsstellung und Organakzeptanz nur versucht werden, die ehemals erreichten Erfolge mit exzellentem Kurz- und Langzeitüberleben (1-Jahres-Überleben von 90 %, 20-Jahres-Überleben von 50 %) wieder zu ermöglichen. [ABSTRACT FROM AUTHOR]

The surgical treatment of hepatopancreatobiliary (HPB) diseases requires complex operative procedures. Within the last decades the morbidity (36-50 %) and mortality (<5 %) of these procedures could be reduced; nonetheless, postoperative complications still occur in 41.2 % of cases. Compared with hepatobiliary procedures, pancreatic surgery shows an increased rate of complications. Postoperative bleeding has a major effect on the outcome and the incidence is 6.7 % after pancreatic surgery and 3.2 % after hepatobiliary surgery. The major causes of early postoperative hemorrhage are related to technical difficulties in surgery whereas late onset postoperative hemorrhage is linked to anastomosis insufficiency, formation of fistulae or abscesses due to vascular arrosion or formation of pseudoaneurysms. In many cases, delayed hemorrhage is preceded by a self-limiting sentinel bleeding. The treatment is dependent on the point in time, location and severity of the hemorrhage. The majority of early postoperative hemorrhages require surgical treatment. Late onset hemorrhage in hemodynamically stable patients is preferably treated by radiological interventions. After interventional hemostatic therapy 8.2 % of patients require secondary procedures. In the case of hemodynamic instability or development of sepsis, a relaparotomy is necessary. The treatment concept includes surgical or interventional remediation of the underlying cause of the hemorrhage. Other causes of postoperative morbidity and mortality are arterial and portal venous stenosis and thrombosis. Following liver resection, thrombosis of the portal vein occurs in 8.5-9.1 % and in 11.6 % following pancreatic resection with vascular involvement. Interventional surgical procedures or conservative treatment are suitable therapeutic options depending on the time of diagnosis and clinical symptoms. The risk of morbidity and mortality after HPB surgery can be reduced only in close interdisciplinary cooperation, which is particularly true for vascular complications. [ABSTRACT FROM AUTHOR]

We describe the case of a 48-year-old patient presenting with abdominal pain with a history of cerebral ischemia due to a patent foramen ovale with heterozygous factor V mutation. Initial work-up demonstrate a significant thrombosis of the portal venous system combined with signs of portal hypertension (ascites, oesophageal varices). Ultrasound reveals no signs of cirrhosis of the liver. Finally a JAK2 mutation can be detected. Prevention of oesophageal varices is refused. Finally a massive haemorrhage occured. [ABSTRACT FROM AUTHOR]

Portosystemic shunt surgery in addition to transjugular intrahepatic portosystemic shunt (TIPS) insertion must still be regarded as a current treatment option for portomesenteric decompression in patients with pharmacological and endoscopic treatment failure, where liver transplantation is not imminent. This applies to secondary prophylaxis of rebleeding from varices in patients with well preserved liver function, e.g. liver cirrhosis CHILD A or extrahepatic portal vein thrombosis. Even if emergency endoscopy represents the treatment of choice in the acute bleeding situation, latest data from San Diego on emergency portacaval shunt surgery are encouraging. Likewise, portacaval shunt procedures can be an attractive alternative to TIPS or liver transplantation for acute Budd-Chiari syndrome or veno-occlusive disease. This article is an update on the systematics and methodology of portacaval shunt surgery, emphasizing the significance of this treatment option based on latest studies. [ABSTRACT FROM AUTHOR]

We report the case of a 68 year old immuncompetent woman with persisting fever. Symptomatic acute CMV infection with a partial thrombosis of the left portal vein branch was diagnosed. [ABSTRACT FROM AUTHOR]

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Abdominal Pain Caused by Viral Infection Is Not Always Trivial Abstract. We report on a 28-year-old previously healthy patient with initially elevated temperature and cough and developing most severe epigastric pain and peritonism in the right upper abdomen. A "bedside" sonography revealed a portal vein thrombosis, the CT additionally partial thromboses of the vena lienalis, vena mesenterica superior. During the examination, a SARS-CoV-2 infection (IgM, IgG) was confirmed. Currently (pandemic), extrapulmonary thromboembolism must also be considered. For this purpose, sonography is the appropriate "search method" - it can be used from "head to toe", immediately and at the "bedside".

Background: The frontiers in liver transplantation are intrinsically expansions of indications, e.g. hepatocellular carcinoma and (perihilar) cholangiocarcinoma, recipients with more severe concomitant diagnoses or "soft" contraindications and technically demanding reconstruction procedures of vascular structures (for portal vein thrombosis or aorto-hepatic conduits). In addition, an extension of the donor pool with suboptimal donor organs (old donors and steatotic livers) is of interest., Methods: This article presents the current situation based on personal experiences in daily practice and an appropriate literature review., Results: A significant reduction of 1‑year patient survival has been reported in Germany. The percentage of so-called marginal donor organs is inversely proportional to the very low donation rate and parallel to the waiting list mortality. Simultaneously, the proportion of inpatients with multiple organ failure is rising., Conclusion: Results-oriented and controlled liver transplantation currently prohibits making inroads into the previously intrinsic frontiers. As long as the current circumstances do not change, a shift in the intrinsic frontiers of that which is surgically feasible will not be possible. The current situation forces the transplant surgeon to apply a more restrictive indications and organ acceptance policy. With this approach we can try to regain the previously excellent short- and long-term results of a 1‑year survival of 90% and a 20-year survival of 50%.