A Case of Idiopathic Portal Hypertension-Improvement of Portal Venous Flow to the Liver Following Hassab's Operation

We compared the portal hemodynamic changes in a patient with idiopathic portal hypertension (IPH) before and after operation. With a diagnosis of IPH with esophagogastric varices, a 41-year-old woman underwent Hassab's operation. The histological findings of the resected liver biopsy were consistent with IPH. The portal phase of celiac arteriography performed preoperatively revealed an unclear image of the peripheral portal branch. On the other hand, the peripheral portal branch was clearly imaged, postoperatively. 99mTc-labelled in vivo blood cell scintography performed preoperatively showed that the radioactive counts from the regions of interest (ROI) over the right liver was less than those from the ROI over the trunks of the portal vein (PV) and the umbilical portion of the portal vein (UP). Postoperatively, however, the radioactive counts over the right liver increased and were greater than counts measured over the PV and UP region. Per-rectal portal scintography with Iodine-123-Iodoamphetamine performed preoperatively revealed early phase lung images, but no early phase liver images, thus suggesting that the radionuclide flowed into the inferior vena cava through a collateral vein. However, both the liver and lungs were clearly visualized in the early phase of scintography performed postoperatively, which meant the amount of blood flow via the porto-systemic shunt had decreased. In conclusion, these findings suggest that the portal hemodynamic state in a patient with IPH may change with apparently improved liver perfusion from portal flow following Hassab's operation.