Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment

Abstract

A patent umbilical vein is a rare condition in healthy volunteers, but can be detected in up to 11% of patients with liver cirrhosis as a consequence of portal hypertension.

We report the case of a 52-year-old woman who was admitted to our department with acute abdominal pain after blunt trauma to her forehead and abdomen. She had a history of alcohol abuse with liver cirrhosis that had been classified as Child–Pugh stage C 5 years earlier. Signs of portosystemic shunting had been present at an earlier endoscopy, and esophageal varices were found.

Clinical examination revealed typical signs of liver cirrhosis, and ultrasound examination showed an aneurysm of 6 cm of the umbilical vein, which had not been present at earlier examinations. After lowering portal hypertension by inserting a transjugular intrahepatic portosystemic shunt, an open surgical resection of the aneurysmal umbilical vein was performed without complications. The patient recovered well and was discharged from the hospital 10 days later.

We hypothesize that the abdominal trauma prompted or aggravated umbilical vein aneurysm in this patient with liver cirrhosis and portal hypertension. Due to the risk of rupture, a surgery-based resection is a valuable treatment option.

Keywords

liver cirrhosis - patent paraumbilical vein - posttraumatic aneurysm - TIPS

• References

• 1 Chen CH, Wang JH, Lu SN. , et al. Comparison of prevalence for paraumbilical vein patency in patients with viral and alcoholic liver cirrhosis. Am J Gastroenterol 2002; 97 (09) 2415-2418
• 2 Zardi EM, Uwechie V, Caccavo D. , et al. Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance. J Gastroenterol 2009; 44 (01) 76-83
• 3 Altinbas A, Sowa JP, Hasenberg T, Canbay A. The diagnosis and treatment of non-alcoholic fatty liver disease. Minerva Gastroenterol Dietol 2015; 61 (03) 159-169
• 4 Chang JB, Stein TA, Liu JP, Dunn ME. Risk factors associated with rapid growth of small abdominal aortic aneurysms. Surgery 1997; 121 (02) 117-122
• 5 Jalan R, Hayes PC. British Society of Gastroenterology. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2000; 46 (Suppl 3-4): III1-III15
• 6 European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53 (03) 397-417
• 7 Fujimoto J. Gene therapy for liver cirrhosis. J Gastroenterol Hepatol 2000; 15 (Suppl): D33-D36
• 8 Hara Y, Sato Y, Yamamoto S. , et al. Successful laparoscopic division of a patent ductus venosus: report of a case. Surg Today 2013; 43 (04) 434-438