Double selective shunting for esophagogastric and rectal varices in portal hypertension due to congenital hepatic polycystic disease.
A 55-year-old woman with ascites, pancytopenia by hypersplenism, recurrent hemorrhagic esophagogastric varices, and large rectal varices due to congenital hepatic polycystic disease underwent splenectomy and simultaneous double selective shunt; a left gastric venacaval direct shunt for esophagogastric varices and a sigmoid venous left ovarian vein shunt for rectal varices. Her preoperative Child-Pugh grade was A (score 6). Postoperative course was uneventful. Serum NH3 level decreased from 90 micrograms/dL to 36 micrograms/dL after shunt surgery. She was discharged on the 21st postoperative day. The remarkable improvement of both the esophagogastric varices and the rectal varices was demonstrated by postoperative fiberscope. We strongly consider sigmoid venous left ovarian shunting to be as selective as the Inokuchi shunt preventing encephalopathy and an effective surgical approach to anorectal varices.
Sato
Yoshinobu
Y
First Department of Surgery, Niigata University School of Medicine, 1-757 Asahimachi-dori, Niigata 951-8510, Japan. kanishok@med.niigata-u.ac.jp
Yokoyama
Naoyuki
N
Suzuki
Susumu
S
Tani
Tatsuo
T
Nomoto
Minoru
M
Hatakeyama
Katsuyoshi
K
D003560:Cysts / Q000150:complications* / Q000151:congenital; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications* / Q000151:congenital; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D012002:Rectal Diseases / Q000209:etiology / Q000601:surgery*; D013156:Splenectomy