title: Pancreatic complications after distal splenorenal shunt.
abstract: Pancreatic complications after the distal splenorenal shunt have not been commonly recognized. Between January 1978 and June 1993, 154 patients underwent a distal splenorenal shunt, and 11 patients (7%) developed pancreatic complications, of which 4 had pancreatitis alone, and 7 developed pancreatitis-related complications. Etiology of cirrhosis, Child's classification and timing of surgery were not predictive of pancreatic complications. Eight patients (5%) were found to have chronic pancreatitis at the time of surgery, and four of these patients (50%) developed pancreatic complications following distal splenorenal shunt. Eleven early postoperative deaths in our series resulted in an overall operative mortality rate of 7%. Of these eleven patients, 6 (55%) had postoperative pancreatic complications. The operative mortality rate of patients who developed pancreatic complications (55%) after distal splenorenal shunt was significantly greater than that of patients who did not develop pancreatic complications (3%), P < .001. When compared with patients without pancreatitis, those with pancreatitis had significantly greater incidences of complete or partial portal vein thrombosis (55% v 20%, P < .02), severe ascites (64% v 13%, P < .001), and encephalopathy (45% v 3%, P < .001). We reach the following conclusions: (1) although not a frequent complication after distal splenorenal shunt in general, pancreatitis was commonly present in early postoperative deaths and was most likely a major contributor to the demise of those patients; (2) survivors with postdistal splenorenal shunt pancreatitis had a markedly increased morbidity rate; and (3) pancreatic complications after distal splenorenal shunt are more likely to occur in patients with pre-existing chronic pancreatitis.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA.
authors.forename: G
authors.initials: G
authors.lastname: Jin
authors.forename: K M
authors.initials: KM
authors.lastname: Murayama
authors.forename: J S
authors.initials: JS
authors.lastname: Thompson
authors.forename: L F
authors.initials: LF
authors.lastname: Rikkers
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects*; D015996:Survival Rate