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Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension.
Acta Gastroenterol Belg. 1998 Jan-Mar; 61(1):13-6.AG

Abstract

MESENTERICO-LEFT INTRAHEPATIC PORTAL VEIN SHUNT: Original technique to treat symptomatic extrahepatic portal hypertension.

OBJECTIVE

Revascularization of the intrahepatic portal system as decompressive surgery for chronic extrahepatic portal hypertension.

SUMMARY BACKGROUND DATA

In patients with extrahepatic portal hypertension (portal trunk thrombosis in presence of a normal liver), shunt surgery is indicated when patient is bleeding from varices at a site not accessible for the endoscopist. Although surgical portal decompression is an efficient procedure, there is a risk of depriving the liver from the splanchnic venous flow and a risk of developing porto-systemic shunt related side effects.

METHOD

A shunt was created between the superior mesenteric vein and the umbilical portion of the left portal vein. This technique allows to bypass the thrombosed portion of the portal vein but avoiding dissection of the cavernoma in the liver hilum and related risk of intraoperative hemorrhage.

RESULTS

The procedure was successfully performed in one adult patient considered unshuntable in view of classic surgical procedures and in whom sclerotherapy was unsuccessful. This operation achieved an effective decompression of the splanchnic venous system.

CONCLUSION

Rerouting the venous splanchnic flow through the liver was possible. It had the major physiological advantage of restoring the normal hepatic vascularization. It also avoided putting the patient at risk of developing porto-systemic shunt related side effects. This option should be considered when shunt procedures are indicated in patients with extrahepatic portal hypertension.

Authors+Show Affiliations

de Ville de Goyet J
Departments of Pediatric Surgery, Cliniques Universitaires St Luc, Catholic University of Louvain, Brussels, Belgium.
Martinet JP
No affiliation info available
Lacrosse M
No affiliation info available
Goffette P
No affiliation info available
Melange M
No affiliation info available
Lerut J
No affiliation info available

MeSH

HumansHypertension, PortalMaleMesenteric VeinsMiddle AgedPortacaval Shunt, SurgicalPortal VeinThrombosis

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9629766

Citation

de Ville de Goyet, J, et al. "Mesenterico-left Intrahepatic Portal Vein Shunt: Original Technique to Treat Symptomatic Extrahepatic Portal Hypertension." Acta Gastro-enterologica Belgica, vol. 61, no. 1, 1998, pp. 13-6.
de Ville de Goyet J, Martinet JP, Lacrosse M, et al. Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension. Acta Gastroenterol Belg. 1998;61(1):13-6.
de Ville de Goyet, J., Martinet, J. P., Lacrosse, M., Goffette, P., Melange, M., & Lerut, J. (1998). Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension. Acta Gastro-enterologica Belgica, 61(1), 13-6.
de Ville de Goyet J, et al. Mesenterico-left Intrahepatic Portal Vein Shunt: Original Technique to Treat Symptomatic Extrahepatic Portal Hypertension. Acta Gastroenterol Belg. 1998 Jan-Mar;61(1):13-6. PubMed PMID: 9629766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension. AU - de Ville de Goyet,J, AU - Martinet,J P, AU - Lacrosse,M, AU - Goffette,P, AU - Melange,M, AU - Lerut,J, PY - 1998/6/18/pubmed PY - 1998/6/18/medline PY - 1998/6/18/entrez SP - 13 EP - 6 JF - Acta gastro-enterologica Belgica JO - Acta Gastroenterol Belg VL - 61 IS - 1 N2 - UNLABELLED: MESENTERICO-LEFT INTRAHEPATIC PORTAL VEIN SHUNT: Original technique to treat symptomatic extrahepatic portal hypertension. OBJECTIVE: Revascularization of the intrahepatic portal system as decompressive surgery for chronic extrahepatic portal hypertension. SUMMARY BACKGROUND DATA: In patients with extrahepatic portal hypertension (portal trunk thrombosis in presence of a normal liver), shunt surgery is indicated when patient is bleeding from varices at a site not accessible for the endoscopist. Although surgical portal decompression is an efficient procedure, there is a risk of depriving the liver from the splanchnic venous flow and a risk of developing porto-systemic shunt related side effects. METHOD: A shunt was created between the superior mesenteric vein and the umbilical portion of the left portal vein. This technique allows to bypass the thrombosed portion of the portal vein but avoiding dissection of the cavernoma in the liver hilum and related risk of intraoperative hemorrhage. RESULTS: The procedure was successfully performed in one adult patient considered unshuntable in view of classic surgical procedures and in whom sclerotherapy was unsuccessful. This operation achieved an effective decompression of the splanchnic venous system. CONCLUSION: Rerouting the venous splanchnic flow through the liver was possible. It had the major physiological advantage of restoring the normal hepatic vascularization. It also avoided putting the patient at risk of developing porto-systemic shunt related side effects. This option should be considered when shunt procedures are indicated in patients with extrahepatic portal hypertension. SN - 1784-3227 UR - https://www.unboundmedicine.com/medline/citation/9629766/Mesenterico_left_intrahepatic_portal_vein_shunt:_original_technique_to_treat_symptomatic_extrahepatic_portal_hypertension_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -