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Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures.
Surg Gynecol Obstet. 1987 Jun; 164(6):530-6.SG

Abstract

The cause and treatment of early variceal bleeding in 15 patients who had undergone distal splenorenal shunt were reviewed. Eight of these patients were taken from a group of 91 who underwent selective shunts from July 1983 through June 1985 and had extensive preoperative and postoperative evaluation of shunt patency and pressure gradient. Seven patients operated upon before July 1983 were reviewed because they illustrate the cause, diagnosis, successful and unsuccessful management of bleeding after selective shunt. Urgent selective arteriography combined with shunt catheterization is the key diagnostic and therapeutic maneuver. Thrombosis of the shunt can be successfully managed by revising the anastomosis. Stenosis of the shunt can be successfully treated with balloon dilation or operative revision of the anastomosis. When renal vein hypertension (RVH) occurs, there might be inadequate decompression of the varices. A gradient of 10 millimeters of mercury or greater from left renal vein to vena cava is diagnostic. Measurements of 30 patients who had no bleeding and one patient with documented RVH show the gradient decreases over time. Treatment should be supportive until this adaptation occurs. Hemorrhage can also occur in patients with a patient shunt but without a significant pressure gradient. Inadequate decompression of the varices through the short gastric veins leading to the spleen has been proposed as one cause. Termed short gastric hypertension, this syndrome could be expected to parallel RVH because the venous collaterals will enlarge and eventually decompress the varices. Treatment should be aimed toward supporting the patient until this adaptation occurs. A small number of patients continue to bleed despite these therapeutic interventions but can sometimes be salvaged with a total shunt.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

3495894

Citation

Richards, W O., et al. "Evaluation and Treatment of Early Hemorrhage of the Alimentary Tract After Selective Shunt Procedures." Surgery, Gynecology & Obstetrics, vol. 164, no. 6, 1987, pp. 530-6.
Richards WO, Pearson TC, Henderson JM, et al. Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures. Surg Gynecol Obstet. 1987;164(6):530-6.
Richards, W. O., Pearson, T. C., Henderson, J. M., Millikan, W. J., & Warren, W. D. (1987). Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures. Surgery, Gynecology & Obstetrics, 164(6), 530-6.
Richards WO, et al. Evaluation and Treatment of Early Hemorrhage of the Alimentary Tract After Selective Shunt Procedures. Surg Gynecol Obstet. 1987;164(6):530-6. PubMed PMID: 3495894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation and treatment of early hemorrhage of the alimentary tract after selective shunt procedures. AU - Richards,W O, AU - Pearson,T C, AU - Henderson,J M, AU - Millikan,W J,Jr AU - Warren,W D, PY - 1987/6/1/pubmed PY - 2001/3/28/medline PY - 1987/6/1/entrez SP - 530 EP - 6 JF - Surgery, gynecology & obstetrics JO - Surg Gynecol Obstet VL - 164 IS - 6 N2 - The cause and treatment of early variceal bleeding in 15 patients who had undergone distal splenorenal shunt were reviewed. Eight of these patients were taken from a group of 91 who underwent selective shunts from July 1983 through June 1985 and had extensive preoperative and postoperative evaluation of shunt patency and pressure gradient. Seven patients operated upon before July 1983 were reviewed because they illustrate the cause, diagnosis, successful and unsuccessful management of bleeding after selective shunt. Urgent selective arteriography combined with shunt catheterization is the key diagnostic and therapeutic maneuver. Thrombosis of the shunt can be successfully managed by revising the anastomosis. Stenosis of the shunt can be successfully treated with balloon dilation or operative revision of the anastomosis. When renal vein hypertension (RVH) occurs, there might be inadequate decompression of the varices. A gradient of 10 millimeters of mercury or greater from left renal vein to vena cava is diagnostic. Measurements of 30 patients who had no bleeding and one patient with documented RVH show the gradient decreases over time. Treatment should be supportive until this adaptation occurs. Hemorrhage can also occur in patients with a patient shunt but without a significant pressure gradient. Inadequate decompression of the varices through the short gastric veins leading to the spleen has been proposed as one cause. Termed short gastric hypertension, this syndrome could be expected to parallel RVH because the venous collaterals will enlarge and eventually decompress the varices. Treatment should be aimed toward supporting the patient until this adaptation occurs. A small number of patients continue to bleed despite these therapeutic interventions but can sometimes be salvaged with a total shunt. SN - 0039-6087 UR - https://www.unboundmedicine.com/medline/citation/3495894/Evaluation_and_treatment_of_early_hemorrhage_of_the_alimentary_tract_after_selective_shunt_procedures_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -