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Early variceal rebleeding after successful distal splenorenal shunt.
Arch Surg. 1986 May; 121(5):547-52.AS

Abstract

Of 77 patients with repeated variceal hemorrhage who underwent distal splenorenal shunt, five (6.5%) developed rebleeding despite a patent splenorenal anastomosis. Three of the five patients died. Early variceal rebleeding usually indicates shunt thrombosis but may occur with a patent anastomosis. Anatomic or functional left renal vein and/or splenic vein hypertension producing incomplete variceal decompression is generally the cause. Ineffective separation of the main portal vein from the gastrosplenic venous plexus may coexist and further intensify variceal congestion. Urgent angiographic studies and direct shunt catheterization with measurement of splenic vein, left renal vein, and inferior vena cava pressures should be performed to plan appropriate therapy. A significant gradient between the splenic and renal veins is evidence of an unsatisfactory anastomosis and should be managed by balloon angioplasty or reoperation. High splenic and left renal vein pressures with a gradient of more than 10 mm Hg between the renal vein and the inferior vena cava indicate renal vein hypertension. Initial therapy should include serial injection sclerotherapy, as renal vein hypertension will usually resolve over time as additional collaterals develop. However, persistent or recurrent variceal hemorrhage may require total portal decompression to bypass the restrictive left renal vein segment.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

3486647

Citation

Eckhauser, F E., et al. "Early Variceal Rebleeding After Successful Distal Splenorenal Shunt." Archives of Surgery (Chicago, Ill. : 1960), vol. 121, no. 5, 1986, pp. 547-52.
Eckhauser FE, Pomerantz RA, Knol JA, et al. Early variceal rebleeding after successful distal splenorenal shunt. Arch Surg. 1986;121(5):547-52.
Eckhauser, F. E., Pomerantz, R. A., Knol, J. A., Strodel, W. E., Williams, D. M., & Turcotte, J. G. (1986). Early variceal rebleeding after successful distal splenorenal shunt. Archives of Surgery (Chicago, Ill. : 1960), 121(5), 547-52.
Eckhauser FE, et al. Early Variceal Rebleeding After Successful Distal Splenorenal Shunt. Arch Surg. 1986;121(5):547-52. PubMed PMID: 3486647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early variceal rebleeding after successful distal splenorenal shunt. AU - Eckhauser,F E, AU - Pomerantz,R A, AU - Knol,J A, AU - Strodel,W E, AU - Williams,D M, AU - Turcotte,J G, PY - 1986/5/1/pubmed PY - 1986/5/1/medline PY - 1986/5/1/entrez SP - 547 EP - 52 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 121 IS - 5 N2 - Of 77 patients with repeated variceal hemorrhage who underwent distal splenorenal shunt, five (6.5%) developed rebleeding despite a patent splenorenal anastomosis. Three of the five patients died. Early variceal rebleeding usually indicates shunt thrombosis but may occur with a patent anastomosis. Anatomic or functional left renal vein and/or splenic vein hypertension producing incomplete variceal decompression is generally the cause. Ineffective separation of the main portal vein from the gastrosplenic venous plexus may coexist and further intensify variceal congestion. Urgent angiographic studies and direct shunt catheterization with measurement of splenic vein, left renal vein, and inferior vena cava pressures should be performed to plan appropriate therapy. A significant gradient between the splenic and renal veins is evidence of an unsatisfactory anastomosis and should be managed by balloon angioplasty or reoperation. High splenic and left renal vein pressures with a gradient of more than 10 mm Hg between the renal vein and the inferior vena cava indicate renal vein hypertension. Initial therapy should include serial injection sclerotherapy, as renal vein hypertension will usually resolve over time as additional collaterals develop. However, persistent or recurrent variceal hemorrhage may require total portal decompression to bypass the restrictive left renal vein segment. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/3486647/Early_variceal_rebleeding_after_successful_distal_splenorenal_shunt_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/vol/121/pg/547 DB - PRIME DP - Unbound Medicine ER -