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Right-side rotation of the graft is an uncommon event after pediatric living donor liver transplantation (LDLT) with a left-sided graft. However, graft rotation might lead to gradual portal vein (PV) stretching and late portal vein complications (PVCs). The goal of this study was to quantify the degree of graft rotation (R) by computed tomography (CT) and to determine the effect of graft rotation on the development of late PVCs. One hundred ten patients underwent LDLT with left-sided grafts between 1996 and 2009; CT images were available and were reviewed for 66 of these patients. To quantify R, the following variables were measured with CT: the longest distance between the midline and the extrahepatic PV at the level of the hepatic hilum (A), the distance between the midline and the center of the superior mesenteric vein at the level of the confluence of the splenic vein and superior mesenteric vein (B), and the inner transverse diameter of the body cavity at the level at which A was measured (C). R was calculated as (A - B)/C. In patients with a patent PV (n = 59) and in patients with late PVCs (n = 7), the median R values were 0.16 (range = 0.03-0.38) and 0.25 (range = 0.13-0.39), respectively; there was a significant difference between the 2 groups (P = 0.003). Multivariate analysis showed that R ≥ 0.2 was the only independent risk factor for the development of late PVCs (P = 0.021). In conclusion, the gradual stretching of the PV after right-side rotation of left-sided grafts might play an important role in the development of late PVCs. PV patency should be closely monitored when graft rotation is noted during clinical follow-up., (Copyright © 2011 American Association for the Study of Liver Diseases.)

Abnormalities of the intra-abdominal umbilical venous connections are rare congenital vascular anomalies. We report a case of an aneurismal dilatation of an umbilical vein directly connected to the portal vein, vital for the delivery of placental blood in the fetus. A term female newborn presented with a dilated umbilical vein detected by prenatal ultrasound. CT angiography revealed an aneurismal dilatation of a vascular structure, from the umbilical ring to the main portal vein. Follow-up CT angiography showed thrombus progression up to the level of SMV inlet. A laparotomy revealed that the normal course of the umbilical vein was absent. The aneurysm was resected and no thrombus was noted in the aneurysm. Post-operative ultrasound revealed an isolated thrombus at the right main portal vein that resolved spontaneously on the follow-up ultrasound. At the 6-month post-operative follow-up, the baby was well and without complications. Although not evaluated for the presence of a ductus venosus, this anomalous umbilical-portal venous connection might have been associated with an absent ductus venosus.

Abstract: Massive bleeding from the porta hepatis is a rare complication after a Kasai portoenterostomy and usually requires urgent surgical intervention. Among the causes of the porta hepatis bleeding, bleeding from the injured caudate arterial branches has never been reported. Here, we describe 2 cases of caudate arterial branch bleeding after a Kasai portoenterostomy, which were successfully treated with transcatheter arterial embolization without laparotomy. [Copyright &y& Elsevier]