Surgical portosystemic shunts and the Rex bypass in children: a single-centre experience

Abstract

Portosystemic shunts and Rex bypass have been used to manage portal hypertension with excellent outcomes. In selected children with compensated liver disease, PSS may act as a bridge to liver transplantation or represent an attractive alternative.

Huge Varicose Inferior Mesenteric Vein: an Unanticipated 99m Tc-labeled Red Blood Cell Scintigraphy Finding

“…The therapeutic alternatives for bleeding varices include conservative medical therapy, surgical options such as portosystemic shunt, or percutaneous treatment with either embolization or transjugular intrahepatic portosystemic shunt (TIPS) [2]. Portosystemic shunt has been utilized in children with extrahepatic portal vein thrombosis when variceal bleeding is refractory to medical or endoscopic therapy [22]. Accordingly, this method has been chosen for our patient.…”

Therapeutic Challenges for Symptomatic Portal Cavernoma Cholangiopathy

“…The interposition of a graft between the superior mesenteric vein and the inferior vena cava improved the performance of the shunt [20,21]. A correct graft diameter (<14 mm) is of particular importance as it ensures proper hepatic perfusion as well as the prevention of hepatic encephalopathy [22,23]. Traditional surgical portosystemic shunts are associated with a high operative morbidity, which has spurred the development of minimally invasive radiology techniques -transjugular intrahepatic portosystemic shunt, direct intrahepatic portacaval shunt and percutaneous mesocaval shunt [24].…”

Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists

“…Other indications include the presence of isolated gastric varices, portal hypertensive bilopathy, small for size syndrome in liver transplantation and contraindications to, or re-bleeding after, TIPS [10][11][12]. Familial hypercholesterolemia is another indication for SPSS in children and proved to be effective in reducing hepatic synthesis of both cholesterol and lipoproteins, although liver transplantation is now the treatment of choice [6,13].…”

“…Surgical portosystemic shunts are divided into two categories (Table 1) based on complete or partial diversion of the splanchnic venous flow [6]: Non-selective SPSSs (Fig. 1) are designed to decompress the portal venous circulation with complete diversion of portal blood flow from the liver into the systemic circulation.…”

“…SPSS is one of the accepted methods of treatment for refractory gastrointestinal haemorrhage due to portal hypertension [5,6]. It is the formation of a vascular connection between the portal venous circulation (superior mesenteric, portal or splenic vein) and http://dx.doi.org/10.1016/j.ejrad.2015.04.021 0720-048X/© 2015 Elsevier Ireland Ltd. All rights reserved.…”