title: Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited.
abstract: PV thrombosis is not an uncommon occurrence following pediatric LT. Symptomatic PHT following PV thrombosis is treated medically, surgical portosystemic shunting (mesorex, splenorenal, and mesocaval) being reserved for refractory cases. A 10-yr-old boy suffered recurrent malena and hemorrhagic shock because of chronic PV thrombosis following LT nine yr ago (1999). Extensive work-up failed to localize the bleeding source. The liver function remained normal. Initial attempts at surgical shunts failed owing to thrombosis (mesocaval 2001, splenorenal, inferior mesenteric-left renal vein, splenic-left external iliac vein 2008). In this situation, we performed a Clatworthy shunt by anastomosing the divided lower end of the LCIV to the side of SMV. There was a single, large caliber anastomosis. Post-operatively, the malena stopped completely, and clinically, there was no lower limb edema or encephalopathy. Doppler USG revealed persistence of hepatopetal flow within the portal collaterals. Follow-up at two yr reveals stable hepatic function with a patent shunt. To the best of our knowledge, we are not aware of a Clatworthy shunt being performed in a transplant setting. We reviewed the literature pertaining to this shunt in non-transplant patients with PHT.
authors.affiliation: Departments of Paediatric Surgery, National University Hospital, Singapore. vidyadhar69@yahoo.co.in
authors.forename: V P
authors.initials: VP
authors.lastname: Mali
authors.forename: P A
authors.initials: PA
authors.lastname: Robless
authors.forename: M
authors.initials: M
authors.lastname: Aw
authors.forename: D L
authors.initials: DL
authors.lastname: Loh
authors.forename: S H
authors.initials: SH
authors.lastname: Quak
authors.forename: K
authors.initials: K
authors.lastname: Prabhakaran
mesh_terms: D002648:Child; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*