Transhepatic obliteration of gastroesophageal varices: results in acute and nonacute bleeders

Seventy-three patients with hepatic cirrhosis and bleeding gastroesophageal varices underwent transhepatic portal vein catheterization and variceal obliteration. Gastroesophageal varices were successfully obliterated in 32 patients actively bleeding and in 35 patients with stabilized bleeding gastroesophageal varices. The remaining six were technical failures. Follow-up examinations in 10 patients from 1 month to 3 years later showed persistent obliteration of embolized veins. Recurrence of variceal bleeding occurred in nine patients. This method should be considered as a palliative, effective adjuvant to the medical treatment of patients with bleeding gastroesophageal varices

Distribution of liver metastases based on the site of primary pancreatic carcinoma

OBJECTIVES:To investigate whether the different location of pancreatic adenocarcinoma affects the lobar distribution of metastases to the liver.METHODS:From all patients who underwent multidetector computed tomography (MDCT) examinations for staging of pancreatic adenocarcinoma in the last 4 years we selected 80 patients (42 men, 38 women; mean age, 60.56 years) with liver metastases and a pancreatic adenocarcinoma of the head (group A, 40 patients; diameter, 32.41 ± 2.28 mm) or body-tail (group B, 40 patients; diameter, 52.21 ± 2.8 mm). We analysed tumour site, diameter, vascular invasion and number of metastases in each lobe of the liver. The total number of metastases was compared between the two groups with an unpaired t-test, while Fisher's test was used to compare the number of metastases within the two lobes.RESULTS:As expected, the number of liver metastases was higher in group B than in group A. The ratio of metastases in the right-to-left hemi-liver was 7.4:1 for group A compared with 3.3:1 for group B (p < 0.0001).CONCLUSIONS:Although the number of liver metastases is higher in the right lobe than in the left lobe in both groups, there is a significant difference in the ratio of metastases between the right and the left hemi-liver. This supports the existence of a streamline phenomenon and a selective lobar distribution of metastases within the liver.KEY POINTS:• Pancreatic adenocarcinoma presents with liver metastases in 40 % of cases • The presence of liver metastases disqualifies the patient from curative surgery • The distribution of metastases within the liver depends on the site of pancreatic adenocarcinoma • The distribution of liver metastases is due to the streamline phenomenon