Cause and management of upper gastrointestinal bleeding after distal splenorenal shunt.
BACKGROUND
The aims of this study were to determine the causes of recurrent upper gastrointestinal hemorrhage (UGH) after distal splenorenal shunting (DSRS) and to summarize our experience in the prevention and management of this complication.


METHODS
This study is based on a retrospective review of 145 consecutive patients undergoing DSRS from 1978 through 1991.


RESULTS
Recurrent UGH developed in 19 patients (13%), most frequently secondary to residual portal hypertension (84%). Eight patients had shunt thrombosis and 11 had patent shunts. The incidence of shunt thrombosis was significantly greater in patients whose splenic vein was less than or equal to 8 mm in diameter (44%) than those whose splenic vein was greater than 8 mm (7%, p less than 0.001). The frequency of shunt failure from 1985 through 1991 was significantly lower (2%) than from 1978 through 1984 (10%, p less than 0.05). Five patients, all with occluded shunts, underwent surgical treatment for recurrent UGH and three died (60%). Fourteen patients were managed nonoperatively, with a mortality rate of 38%.


CONCLUSIONS
Recurrent UGH after DSRS occurs in patients with patent shunts and in those with occluded shunts; DSRS thrombosis is more frequent when the splenic vein diameter is less than or equal to 8 mm; DSRS thrombosis decreases with operative experience; and the mortality rate for this complication is high with both operative and nonoperative management.
Jin
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Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Rikkers
L F
LF
D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects*; D013997:Time Factors