title: Restoration of portal vein flow by splenorenal shunt ligation and splenectomy after living-related liver transplantation.
abstract: We describe here a case of living-related liver transplantation with a spontaneous splenorenal shunt. On the third postoperative day, Doppler ultrasound follow-up revealed impairment of intrahepatic portal vein flow and reoperation was performed. Intraoperatively, simple compression of the collateral veins forming the splenorenal shunt resulted in an immediate change in the portal flow pattern, which suggested the absence of a portal thrombus. Splenectomy and ligature of the more dilated collateral veins were carried out and satisfactory portal flow was restored. Although the role of splenectomy was controversial, splenectomy provided an increased portal vein flow in the present case. The uneventful postoperative course validated our decision.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: Y
authors.initials: Y
authors.lastname: Sugawara
authors.forename: J
authors.initials: J
authors.lastname: Kaneko
authors.forename: H
authors.initials: H
authors.lastname: Ohtsuka
authors.forename: T
authors.initials: T
authors.lastname: Takayama
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D013156:Splenectomy; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D018608:Ultrasonography, Doppler