"Rex shunt" for the treatment of portal vein thrombosis after pediatric liver transplantation: a case report.
OBJECTIVE
Late portal vein thrombosis (PVT) can be extremely well tolerated, although portal hypertension and other consequences of the long-term deprivation of portal inflow to the graft may be hazardous, especially in young children. Recently, the "Rex shunt" has been used successfully to treat these patients. We now report the initial experience with this novel technique.


METHODS
A 3-year-old girl with PVT at 7 months after whole organ cadaveric liver transplant displayed portal hypertension with an episode of gastrointestinal bleeding, requiring a mesenteric-portal surgical shunt ("Rex shunt") using a left internal jugular vein autograft.


RESULTS
Upon current follow-up of 6 months, postoperative Doppler ultrasound confirmed shunt patency. Endoscopic status was significantly improved after surgery with resolution of portal hypertension. There was no recurrence of bleeding.


CONCLUSIONS
The mesenteric-portal shunt ("Rex shunt"), using a left internal jugular vein autograft, should be considered for children with late PVT after liver transplantation. Although this is an initial experience, we may conclude that this technique is feasible, with great potential benefits and low risks for these patients.
Instituto da Criança, Hospital das Clinicas, Pediatric Surgery and Liver Transplantation Division, Departments of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, Brazil. nelson.gibelli@icr.usp.br
N E M
NE
Gibelli
U
U
Tannuri
M L
ML
de Pinho-Apezzato
A C A
AC
Tannuri
J G
JG
Maksoud-Filho
M C P
MC
Velhote
M M
MM
Santos
A A R
AA
Ayoub
M
M
Marques da Silva
W C
WC
Andrade
D002102:Cadaver; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007601:Jugular Veins / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D013163:Splenomegaly / Q000601:surgery; D014019:Tissue Donors; D014182:Transplantation, Autologous; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*