A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Iannello, Silvia; Libertini, Luciano; Martini, Romeo; Spina, Sebastiano; Busacca, G; Ricciardi, Nunziato; Andreozzi, Giuseppe Maria; Belfiore, Francesco

doi:10.1159/000016944

Cited by 10 publications

(3 citation statements)

References 47 publications

(90 reference statements)

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“…Chronic portal hypertension in patients with liver cirrhosis leads to dilation of the portal, superior mesenteric, splenic and coronary veins and opening of gastroesophageal and splenorenal collaterals. Splenorenal collaterals are the most common spontaneous portosystemic communications (39). In order to create sufficient portal venous flow to the liver graft during LTx in the case of PVT, some authors advocated a deliberate intra‐operative surgical interruption of portosystemic venous communications with or without splenectomy in selected cases to reduce any steal‐effects and portocaval shunting of portal blood flow away from the graft (40–43).…”

Section: Discussionmentioning

confidence: 99%

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Paškonis

Jurgaitis

Mehrabi

et al. 2006

Clinical Transplantation

113

123

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Portal vein thrombosis (PVT), a common complication of end stage liver disease, is no longer considered a definite contraindication for liver transplantation (LTx). The clinical decision to perform an LTx in the case of PVT depends on the degree of PVT and the experience of the surgeon. Eversion thromboendovenectomy was suggested by most authors as the surgical technique of choice for PVT grade 1, 2, and 3. If PVT obstructs more extended parts of the porto-mesenteric venous circulation, surgical options would include different types of venous jump graft reconstructions or arterialization of the portal vein. Combined liver and small bowel transplantation is another possible alternative. Cavoportal hemitransposition (CPHT) and renoportal anastomosis (RPA) were recently particularly advocated as creative surgical strategies in case of diffuse PVT. In this work, we focus on CPHT and RPA surgical techniques during LTx, which attempts to secure the portal flow to the liver graft in case of pre-existent diffuse PVT. We provide a review of all reported clinical experience at international clinical centers using these techniques. According to our meta-analysis a total of 15 studies were published on this topic between 1996 and 2005. In summary, a total of 56 orthotopic LTx have been performed in 53 patients (28 men, 25 women) combined with either CPHT or RPA, for the purpose of providing the donor graft with adequate inflow. Mean age was 44 yr including two patients who were infants, with the youngest recipient being two yr old. Main indications for LTx were liver cirrhosis caused by viral hepatitis, alcoholic cirrhosis and cryptogenic cirrhosis. CPHT was performed in 46 cases, and RPA in 10 cases. Thirty-five of 53 patients (66%) had surgery previous to LTx. Of these, 13 patients (37%) [corrected] presented with a history of other previous surgical procedures for decompression of portal hypertension or treatment of associated complications (portocaval shunts, splenectomy, etc). Ascites, renal dysfunction, lower extremity and torso edema and variceal bleeding were dominant post-operative complications after CPHT or RPA noted in 22 cases (41.5%), 18 cases (34%), 17 cases (32%) and 13 cases (24.5%) respectively. Patients' follow-up ranged from two to 48 months. Thirty nine of 53 patients [corrected] (74%) survived [corrected] and 14 patients died (26%) [corrected] during the course of observation. Based on the literature, we conclude that the ideal technique to overcome PVT during LTx is still controversial. Short-term follow-up results of both methods are promising, however, long-term results are unknown at present. Furthermore, clinical follow-up and basic experimental work is required to evaluate the influence of systemic venous inflow to the liver graft with respect to long-term liver function and liver regeneration.

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Section: Discussionmentioning

confidence: 99%

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Paškonis

Jurgaitis

Mehrabi

et al. 2006

Clinical Transplantation

113

123

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“… (A) Mesorenal shunt in our patient connecting the inferior mesenteric vein and renal vein. Shunts between (B) the splenic vein and the renal vein [ 7 ], (C) the superior mesenteric vein and the renal vein [ 8 ], (D) the inferior mesenteric vein and the inferior vena cava [ 9 ], (E) the left gastric vein and the renal vein [ 10 ], (F) the renal vein and the portal vein [ 11 ], (G) the superior mesenteric vein and the iliac vein [ 12 ], (H) the portal vein and the inferior vena cava [ 13 ], and (I) the azygos vein and the portal vein [ 14 ]. …”

Section: Discussionmentioning

confidence: 99%

Congenital Portosystemic Shunts in Cirrhosis and Portal Vein Thrombosis: A Case Report

Durgham¹,

Tessier²,

Ido³

et al. 2022

Cureus

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Acquired portosystemic shunts (PSS) are abnormal blood vessels that develop between the portal vein and systemic circulation as a result of portal hypertension. Recurrent hyperammonemic encephalopathy in our 62-year-old patient with cirrhosis and chronic portal vein thrombosis led to the discovery of an extremely rare and functioning portosystemic shunt (PSS). The PSS connected the inferior mesenteric and left renal veins. Such shunts are considered pathological structures and may require surgical intervention. The large PSS reported herein likely provided decompression of the portal hypertension. The concurrence of portal vein thrombosis clearly precluded any consideration of surgery. Therapeutic management in each instance of these shunts requires a full understanding of their origination, location, and physiologic implications.

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“…Due to these hemodynamic changes SRS prevents the formation of gastroesophageal varices but does not reduce the risk of bleeding [16, 17] and is associated with an increased risk of complications such as hepatic encephalopathy [18] and HCC [15]. …”

Section: Discussionmentioning

confidence: 99%

Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

Chegai

Cavallo

Forcina

et al. 2017

Case Reports in Radiology

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We present a case of giant Splenorenal Shunt (SRS) associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident. SRS was located among the spleen hilum and the left kidney with a maximum diameter of 3.25 cm and was associated with dilatation of left renal vein and inferior vena cava. After a multidisciplinary evaluation the patient was put on the Regional Liver Transplant waiting list and liver transplantation was performed successfully. Although portal vein thrombosis and SRS are common occurrences in cirrhotic patients, the impact in the natural history of the disease is still unclear. Careful management and accurate imaging protocols are essential in the evaluation of those patients.

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A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Cited by 10 publications

References 47 publications

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Surgical strategies for liver transplantation in the case of portal vein thrombosis – current role of cavoportal hemitransposition and renoportal anastomosis

Congenital Portosystemic Shunts in Cirrhosis and Portal Vein Thrombosis: A Case Report

Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

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