Skip to main content
Top
Published in: BMC Pediatrics 1/2012

Open Access 01-12-2012 | Case report

Abernethy malformation: a case report

Authors: Ashish Pathak, Nitin Agarwal, Jagdish Mandliya, Prateek Gehlot, Mamta Dhaneria

Published in: BMC Pediatrics | Issue 1/2012

Login to get access

Abstract

Background

Abernethy malformation is a very rare congenital vascular malformation defined by diversion of portal blood away from liver. It is commonly associated with multiple congenital anomalies. We present a case of Abernethy malformation, without associated congenital anomalies from India.

Case presentation

A 5-year-old female child presented with short history of jaundice. A provisional diagnosis of acute viral hepatitis was made in view of clinical presentation and local endemicity of viral hepatitis A. Persistence of jaundice on follow up after 4 weeks led to detailed investigations. Ultrasound and doppler study of abdomen revealed drainage of portal vein into inferior vena cava. CT angiography was performed which confirmed the diagnosis of Type 1 b Abernethy malformation without associated major anomalies. We discuss the common clinical presentations, associated anomalies, diagnostic workup and treatment options of this disorder.

Conclusion

The treatment of the patients with congenital porto-systemic shunts depends on the site of the shunt, associated congenital anomalies and the extent of liver damage but the prognosis depends on the complications irrespective of anatomical type. However, the extent of associated abnormalities should not deter paediatricians to refer patients for treatment. Whenever possible closure of the shunt should be advised for cure or to prevent complications. Only symptomatic type I patients with absence of possibility to close the shunt may require liver transplant. Long-term follow-up is indicated for all patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference Abernethy J: Account of two instances of uncommon formation in the viscera of the human body. Philos Trans R Soc. 1793, 83: 59-66. 10.1098/rstl.1793.0010.CrossRef Abernethy J: Account of two instances of uncommon formation in the viscera of the human body. Philos Trans R Soc. 1793, 83: 59-66. 10.1098/rstl.1793.0010.CrossRef
2.
go back to reference Howard ER, Davenport M: Congenital extrahepatic portocaval shunts–the Abernethy malformation. J Pediatr Surg. 1997, 32 (3): 494-497. 10.1016/S0022-3468(97)90614-X.CrossRefPubMed Howard ER, Davenport M: Congenital extrahepatic portocaval shunts–the Abernethy malformation. J Pediatr Surg. 1997, 32 (3): 494-497. 10.1016/S0022-3468(97)90614-X.CrossRefPubMed
3.
go back to reference Morgan G, Superina R: Congenital absence of the portal vein: two cases and a proposed classification system for portasystemic vascular anomalies. J Pediatr Surg. 1994, 29 (9): 1239-1241. 10.1016/0022-3468(94)90812-5.CrossRefPubMed Morgan G, Superina R: Congenital absence of the portal vein: two cases and a proposed classification system for portasystemic vascular anomalies. J Pediatr Surg. 1994, 29 (9): 1239-1241. 10.1016/0022-3468(94)90812-5.CrossRefPubMed
4.
go back to reference Murray CP, Yoo SJ, Babyn PS: Congenital extrahepatic portosystemic shunts. Pediatr Radiol. 2003, 33 (9): 614-620. 10.1007/s00247-003-1002-x.CrossRefPubMed Murray CP, Yoo SJ, Babyn PS: Congenital extrahepatic portosystemic shunts. Pediatr Radiol. 2003, 33 (9): 614-620. 10.1007/s00247-003-1002-x.CrossRefPubMed
5.
go back to reference Witters P, Maleux G, George C, Delcroix M, Hoffman I, Gewillig M, Verslype C, Monbaliu D, Aerts R, Pirenne J, et al: Congenital veno-venous malformations of the liver: widely variable clinical presentations. J Gastroenterol Hepatol. 2008, 23 (8 Pt 2): e390-394.CrossRefPubMed Witters P, Maleux G, George C, Delcroix M, Hoffman I, Gewillig M, Verslype C, Monbaliu D, Aerts R, Pirenne J, et al: Congenital veno-venous malformations of the liver: widely variable clinical presentations. J Gastroenterol Hepatol. 2008, 23 (8 Pt 2): e390-394.CrossRefPubMed
6.
go back to reference Singhal A, Srivastava A, Goyal N, Vij V, Wadhawan M, Bera M, Gupta S: Successful living donor liver transplant in a child with Abernethy malformation with biliary atresia, ventricular septal defect and intrapulmonary shunting. Pediatr Transplant. 2009, 13 (8): 1041-1047. 10.1111/j.1399-3046.2009.01092.x.CrossRefPubMed Singhal A, Srivastava A, Goyal N, Vij V, Wadhawan M, Bera M, Gupta S: Successful living donor liver transplant in a child with Abernethy malformation with biliary atresia, ventricular septal defect and intrapulmonary shunting. Pediatr Transplant. 2009, 13 (8): 1041-1047. 10.1111/j.1399-3046.2009.01092.x.CrossRefPubMed
7.
go back to reference Delle Chiaie L, Neuberger P, Von Kalle T: Congenital intrahepatic portosystemic shunt: prenatal diagnosis and possible influence on fetal growth. Ultrasound Obstet Gynecol. 2008, 32 (2): 233-235. 10.1002/uog.6116.CrossRefPubMed Delle Chiaie L, Neuberger P, Von Kalle T: Congenital intrahepatic portosystemic shunt: prenatal diagnosis and possible influence on fetal growth. Ultrasound Obstet Gynecol. 2008, 32 (2): 233-235. 10.1002/uog.6116.CrossRefPubMed
8.
go back to reference Gitzelmann R, Forster I, Willi UV: Hypergalactosaemia in a newborn: self-limiting intrahepatic portosystemic venous shunt. Eur J Pediatr. 1997, 156 (9): 719-722. 10.1007/s004310050698.CrossRefPubMed Gitzelmann R, Forster I, Willi UV: Hypergalactosaemia in a newborn: self-limiting intrahepatic portosystemic venous shunt. Eur J Pediatr. 1997, 156 (9): 719-722. 10.1007/s004310050698.CrossRefPubMed
9.
go back to reference Ono H, Mawatari H, Mizoguchi N, Eguchi T, Sakura N: Clinical features and outcome of eight infants with intrahepatic porto-venous shunts detected in neonatal screening for galactosaemia. Acta Paediatr. 1998, 87 (6): 631-634. 10.1111/j.1651-2227.1998.tb01521.x.CrossRefPubMed Ono H, Mawatari H, Mizoguchi N, Eguchi T, Sakura N: Clinical features and outcome of eight infants with intrahepatic porto-venous shunts detected in neonatal screening for galactosaemia. Acta Paediatr. 1998, 87 (6): 631-634. 10.1111/j.1651-2227.1998.tb01521.x.CrossRefPubMed
10.
go back to reference Nishimura Y, Tajima G, Dwi Bahagia A, Sakamoto A, Ono H, Sakura N, Naito K, Hamakawa M, Yoshii C, Kubota M, et al: Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. J Inherit Metab Dis. 2004, 27 (1): 11-18.CrossRefPubMed Nishimura Y, Tajima G, Dwi Bahagia A, Sakamoto A, Ono H, Sakura N, Naito K, Hamakawa M, Yoshii C, Kubota M, et al: Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. J Inherit Metab Dis. 2004, 27 (1): 11-18.CrossRefPubMed
11.
go back to reference Sakura N, Mizoguchi N, Eguchi T, Ono H, Mawatari H, Naitou K, Ito K: Elevated plasma bile acids in hypergalactosaemic neonates: a diagnostic clue to portosystemic shunts. Eur J Pediatr. 1997, 156 (9): 716-718. 10.1007/s004310050697.CrossRefPubMed Sakura N, Mizoguchi N, Eguchi T, Ono H, Mawatari H, Naitou K, Ito K: Elevated plasma bile acids in hypergalactosaemic neonates: a diagnostic clue to portosystemic shunts. Eur J Pediatr. 1997, 156 (9): 716-718. 10.1007/s004310050697.CrossRefPubMed
12.
go back to reference Kim MJ, Ko JS, Seo JK, Yang HR, Chang JY, Kim GB: Cheon JE. 2011, Clinical features of congenital portosystemic shunt in children. Eur J Pediatr, Kim WS Kim MJ, Ko JS, Seo JK, Yang HR, Chang JY, Kim GB: Cheon JE. 2011, Clinical features of congenital portosystemic shunt in children. Eur J Pediatr, Kim WS
13.
go back to reference Hoeper MM, Krowka MJ, Strassburg CP: Portopulmonary hypertension and hepatopulmonary syndrome. Lancet. 2004, 363 (9419): 1461-1468. 10.1016/S0140-6736(04)16107-2.CrossRefPubMed Hoeper MM, Krowka MJ, Strassburg CP: Portopulmonary hypertension and hepatopulmonary syndrome. Lancet. 2004, 363 (9419): 1461-1468. 10.1016/S0140-6736(04)16107-2.CrossRefPubMed
14.
go back to reference Ratnasamy C, Kurbegov A, Swaminathan S: Cardiac anomalies in the setting of the Abernethy malformation of the portal vein. Cardiol Young. 2007, 17 (2): 212-214. 10.1017/S1047951106001375.CrossRefPubMed Ratnasamy C, Kurbegov A, Swaminathan S: Cardiac anomalies in the setting of the Abernethy malformation of the portal vein. Cardiol Young. 2007, 17 (2): 212-214. 10.1017/S1047951106001375.CrossRefPubMed
15.
go back to reference Sanada Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Egami S, Hishikawa S, Kawano Y, Ushijima K, et al: The role of operative intervention in management of congenital extrahepatic portosystemic shunt. Surgery. 2011, 15 (3): 404-411. Sanada Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Egami S, Hishikawa S, Kawano Y, Ushijima K, et al: The role of operative intervention in management of congenital extrahepatic portosystemic shunt. Surgery. 2011, 15 (3): 404-411.
16.
go back to reference Crespin J, Nemcek A, Rehkemper G, Blei AT: Intrahepatic portal-hepatic venous anastomosis: a portal-systemic shunt with neurological repercussions. Am J Gastroenterol. 2000, 95 (6): 1568-1571. 10.1111/j.1572-0241.2000.02096.x.CrossRefPubMed Crespin J, Nemcek A, Rehkemper G, Blei AT: Intrahepatic portal-hepatic venous anastomosis: a portal-systemic shunt with neurological repercussions. Am J Gastroenterol. 2000, 95 (6): 1568-1571. 10.1111/j.1572-0241.2000.02096.x.CrossRefPubMed
17.
go back to reference Franchi-Abella S, Branchereau S, Lambert V, Fabre M, Steimberg C, Losay J, Riou JY, Pariente D, Gauthier F, Jacquemin E, et al: Complications of congenital portosystemic shunts in children: therapeutic options and outcomes. J Pediatr Gastroenterol Nutr. 2010, 51 (3): 322-330.PubMed Franchi-Abella S, Branchereau S, Lambert V, Fabre M, Steimberg C, Losay J, Riou JY, Pariente D, Gauthier F, Jacquemin E, et al: Complications of congenital portosystemic shunts in children: therapeutic options and outcomes. J Pediatr Gastroenterol Nutr. 2010, 51 (3): 322-330.PubMed
18.
go back to reference Duprey J, Gouin B, Benazet MF, Le Gal J: Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis. Ann Med Interne (Paris). 1985, 136 (8): 655-658. Duprey J, Gouin B, Benazet MF, Le Gal J: Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis. Ann Med Interne (Paris). 1985, 136 (8): 655-658.
19.
go back to reference Shinkai M, Ohhama Y, Nishi T, Yamamoto H, Fujita S, Take H, Adachi M, Tachibana K, Aida N, Kato K, et al: Congenital absence of the portal vein and role of liver transplantation in children. J Pediatr Surg. 2001, 36 (7): 1026-1031. 10.1053/jpsu.2001.24731.CrossRefPubMed Shinkai M, Ohhama Y, Nishi T, Yamamoto H, Fujita S, Take H, Adachi M, Tachibana K, Aida N, Kato K, et al: Congenital absence of the portal vein and role of liver transplantation in children. J Pediatr Surg. 2001, 36 (7): 1026-1031. 10.1053/jpsu.2001.24731.CrossRefPubMed
20.
go back to reference Collard B, Maleux G, Heye S, Cool M, Bielen D, George C, Roskams T, Van Steenbergen W: Value of carbon dioxide wedged venography and transvenous liver biopsy in the definitive diagnosis of Abernethy malformation. Abdom Imaging. 2006, 31 (3): 315-319. 10.1007/s00261-005-0151-9.CrossRefPubMed Collard B, Maleux G, Heye S, Cool M, Bielen D, George C, Roskams T, Van Steenbergen W: Value of carbon dioxide wedged venography and transvenous liver biopsy in the definitive diagnosis of Abernethy malformation. Abdom Imaging. 2006, 31 (3): 315-319. 10.1007/s00261-005-0151-9.CrossRefPubMed
Metadata
Title
Abernethy malformation: a case report
Authors
Ashish Pathak
Nitin Agarwal
Jagdish Mandliya
Prateek Gehlot
Mamta Dhaneria
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2012
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/1471-2431-12-57

Other articles of this Issue 1/2012

BMC Pediatrics 1/2012 Go to the issue