title: Extra-hepatic portal vein aneurysm: A case report, overview of the literature and suggested management algorithm.
abstract: BACKGROUND
  Portal venous aneurysms are a rare finding. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. However, there is still much to be elicited regarding their aetiology, natural history, and management.
  
  
  METHODS
  An 80-year-old woman presented with abdominal pain and nausea. Investigations showed a hypoechoic area in the region of the head of pancreas on ultrasound, which was found to be a portal venous aneurysm on CT. In view of her multiple comorbidities, a conservative approach was taken.
  
  
  CONCLUSIONS
  Portal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.43%. They may be congenital, due to failure of complete regression of the right vitelline vein, or acquired secondary to portal hypertension. The primary presentation of portal vein aneurysm is abdominal pain, followed by incidental detection on imaging, with a minority of patients presenting with gastrointestinal bleeding. Complications of PVA include thrombosis, biliary tract obstruction, inferior vena cava obstruction, and duodenal compression. On the whole PVAs are stable and have a low risk of complications with 88% of patients showing no progression of aneurysm size or complications on subsequent follow up scans.
  
  
  CONCLUSIONS
  We recommend that portal venous aneurysms be assessed using colour Doppler ultrasonography in the first instance with CT scans reserved for indeterminate cases or symptomatic patients. Due to the slow progression of such aneurysms, surgery is recommended only for symptomatic patients or those with complications secondary to portal venous aneurysms.
authors.affiliation: Department of Hepatobiliary and Pancreas Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Ruichong
authors.initials: R
authors.lastname: Ma
authors.forename: Anita
authors.initials: A
authors.lastname: Balakrishnan
authors.forename: Teik Choon
authors.initials: TC
authors.lastname: See
authors.forename: Siong Seng
authors.initials: SS
authors.lastname: Liau
authors.forename: Raaj
authors.initials: R
authors.lastname: Praseedom
authors.forename: Asif
authors.initials: A
authors.lastname: Jah