Association of Recanalization of the Left Umbilical Vein With Umbilical Hernia in Patients With Liver Disease
Notice bibliographique
Résumé
Transmission of portal hypertension to the umbilical region via a recanalized left umbilical vein may explain the higher prevalence of umbilical hernia than inguinal hernia in men with advanced liver disease. Images from a computed tomography of a 49-year-old man with cirrhosis and hepatocellular carcinoma from hepatitis C virus were reconstructed in 3-dimensional color format. Rupture of the web between the left portal vein and the recanalized left umbilical vein is seen. Penetration of abdominal wall by the varices at the umbilicus is demonstrated. A dilated inferior epigastric vein is seen to drain the varices inferiorly to the right external iliac vein. Umbilical hernia in the general population occurs more frequently in women than men. The difference in prevalence is probably due to pregnancy-related intra-abdominal hypertension and abdominal wall effacement. Umbilical hernia is frequently seen in patients with advanced liver disease. The mechanism is again thought to be high intra-abdominal pressure from ascites and abdominal wall muscle wasting. In men without liver disease inguinal hernia is more common than umbilical hernia, whereas the opposite is true in the presence of liver disease. Abdominal hypertension and muscle wasting promotes both types of hernia. The higher rate of umbilical hernia seen in patients with liver disease may be due to the transmission of portal pressure via the recanalized umbilical vein to the umbilicus.1 This notion is supported by the reduction of umbilical hernia size after portosystemic shunt placement.2 A 49-year-old man with ascites and an umbilical hernia underwent computed tomography of the abdomen during assessment for liver transplantation. He had end-stage liver disease from hepatitis C virus. Blood-test results included the following: albumin, 27 g/L; bilirubin 32 μmol/L; international normalized ratio, 1.6; and platelet count, 79 x 109/L. An alpha fetoprotein level of 49 μg/L and an ultrasound were suspicious for hepatocellular carcinoma. The patient was taking diuretics to control ascites. Computed tomography showed a 2-cm hepatocellular carcinoma in the right lobe of the liver. The umbilical hernia contained large varices that were connected to a dilated tortuous left umbilical vein (Figs. 1, 2 and 3). The varices communicated systemically with the right external iliac vein via the right inferior epigastric vein, which was also dilated. Computed tomography of a patient with end-stage liver disease and hepatocellular carcinoma demonstrating (A) communication between the left umbilical vein and the left portal vein, (B) tortuous path of the dilated left umbilical vein, (C) penetration of the varices through the abdominal wall at the umbilicus, and (D) communication inferiorly to the right external iliac vein via the inferior epigastric vein. Reconstructed 3-dimensional computed tomographic color image of the abdomen (right lateral view) showing varices within an umbilical hernia, communicating superiorly with a tortuous recanalized left umbilical vein and inferiorly with the right inferior epigastric vein. Oblique views of the 3-dimensional color reconstruction showing the communication between the left umbilical vein and the left portal vein. (see the online Supplementary Material at http://www.interscience.wiley.com/jpages/1527-6465/suppmat/) These images demonstrate the ability of chronic portal hypertension to rupture the web between the left portal vein and the obliterated left umbilical vein, resulting in distension and lengthening of the left umbilical vein. Dilated portosystemic connections at the umbilicus become varices. It is reasonable to believe that hypertension in these vessels contribute to weakening of the abdominal wall and herniation at the umbilicus. Ligation of communicating vessels should be considered if varices are encountered during umbilical hernia repair in patients with advanced liver disease. The patient received an orthotopic liver transplantation. A 2-cm hepatocellular cancer in a cirrhotic liver was confirmed by histology. The hernia, which has reduced in size, was repaired 4 months after transplantation. This article contains supplementary material, which may be viewed at the Liver Transplantation website at http://www.interscience.wiley.com/jpages/1527-6465/suppmat/ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».