title: Splenic-intrahepatic left portal shunt in an adult patient with extrahepatic portal vein obstruction without recurrence after pancreaticoduodenectomy.
abstract: In the last decade, a superior mesenteric-intrahepatic left portal shunt (Rex shunt) has been reported for successful management of extrahepatic portal vein obstruction in children. However, in adults, a mesocaval shunt has been generally performed for the surgical management of extrahepatic portal vein obstruction because of the complexity of the underlying disease and the difficulty of the superior mesenteric-intrahepatic left portal shunt. We herein report an adult patient who was successfully treated by splenic-intrahepatic left portal shunt with an artificial graft (6-mm polytetrafluoroethylene) for complete obstruction of the extrahepatic portal vein following pancreaticoduodenectomy. The shunt procedure not only relieved portal hypertension but also restored hepatic portal flow. In the near future, the Rex shunt should be considered for a beneficial management of extrahepatic portal vein obstruction, even in adults.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Niigata, Japan. sugarman@med.niigata-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oya
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakatsuka
authors.forename: Takaoki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Kazuyasu
authors.initials: K
authors.lastname: Takizawa
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D011138:Polytetrafluoroethylene