title: Laparoscopic division of a portosystemic shunt for recurrent life-threatening rectal variceal bleeding: report of a case.
abstract: In patients with severe portal hypertension related to liver cirrhosis, recanalization of umbilical veins may lead to both development and rupture of massive anorectal varices. In this setting, while transjugular intrahepatic portosystemic shunt (TIPS) is considered as the treatment of choice, the management of these patients remains unclear in case of contraindications to TIPS. Laparoscopic division of massive portosystemic shunts has been reported to yield beneficial effects in patients with isolated hepatic encephalopathy but has never been attempted in a context of life-threatening lower gastrointestinal bleeding. In the present case report, we both describe the operative technique of laparoscopic division of recanalized umbilical veins to treat recurrent massive haemorrhage following rupture of giant rectal varices in a 68-year-old Child C cirrhotic patient contraindicated to TIPS and report the postoperative course of the patient.
authors: Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Saint-Antoine, Assistance publique-Hopitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors: François
authors: F
authors: Cauchy
authors: Lilian
authors: L
authors: Schwarz
authors: Raffele
authors: R
authors: Brustia
authors: Ailton
authors: A
authors: Sepulveda
authors: Fabiano
authors: F
authors: Perdigao
authors: Denis
authors: D
authors: Bernard
authors: Astrid
authors: A
authors: Schielke
authors: Olivier
authors: O
authors: Scatton
authors: Olivier
authors: O
authors: Soubrane
mesh_terms: D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D010535:Laparoscopy / Q000379:methods*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D012002:Rectal Diseases / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000098:blood supply*; D014471:Umbilical Veins / Q000601:surgery*; D014648:Varicose Veins / Q000209:etiology / Q000601:surgery*