Top

BMC Surgery

Published in:

Open Access 01-12-2007 | Case report

Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt

Authors: Unal Aydin, Pinar Yazici, Murat Kilic

Published in: BMC Surgery | Issue 1/2007

Abstract

Background

Currently, portal hypertension is still big problem for the patients with serious liver diseases. Variceal bleeding is one of the most important complications of portal hypertension. In case of failure of endoscopic and combined medical treatments, surgical decompressive shunts are required. We emphasized an alternative splenorenal shunt procedure using adrenal vein as a conduit.

Case presentation

A 26-year-old male suffered from recurrent variceal bleeding was considered for surgical therapy. Although we planned to perform a distal splenorenal shunt procedure, it was observed to be difficult. Therefore left adrenal vein was used as a conduit between left renal vein and splenic vein after splenic artery was ligated. He did well and was discharged from the hospital on the postoperative day 6. In the follow up period for nine months, endoscopic and ultrasonographic examinations were normal.

Conclusion

We concluded that, in case of failure to perform distal splenorenal shunt due to technical problems, alternative porto-systemic shunt procedure using the adrenal vein as a vascular conduit can be safely employed.

Available only for authorised users

Inokuchi K: Present status of surgical treatment of esophageal varices in Japan: a nationwide survey of 3,588 patients. World J Surg. 1985, 9 (1): 171-10.1007/BF01656275.CrossRefPubMed

Hassab MA: Gastro-esophageal decongestion and splenectomy GEDS (Hassab), in the management of bleeding varices. Review of literature. Int Surg. 1998, 83 (1): 38-41.PubMed

Wolff M, Hirner A: Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003, 388 (3): 141-149. 10.1007/s00423-003-0367-5.CrossRefPubMed

Warren WD, Henderson JM, Millikan WJ, Galambos JT, Brooks WS, Riepe SP: Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Preliminary report of a prospective, randomized trial. Ann Surg. 1986, 203 (5): 454-62. 10.1097/00000658-198605000-00002.CrossRefPubMedPubMedCentral

Kulkarni VM, Nagral SS, Mathur SK: Use of adrenal vein conduit for splenorenal shunts: a case report. Hepatogastroenterology. 1999, 46 (27): 2033-4.PubMed

Leger L, Pater JC: Spleno-adrenal anastomosis with the Nakayama instrumentation. J Chir. 1964, 88 (2): 371-373.

Moreno GE, de la Calle SA, Hidalgo PM, Figueroa AJ, Landa GI: Selective distal spleno-adrenal bypass. Unusual selective shunt option in hemorrhage causing by esophageal varices. Presentation of a case. Rev Esp enferm Apar Dig. 1981, 59 (6): 709-12.

Jovine E, Cescon M, Ercolani G, Masetti M, Mazziotti A, Cavallari A: Splenorenal shunt. An original portosystemic decompressive technique. Hepatogastroenterology. 2001, 48 (37): 107-108.PubMed

Pujahari AK: Lieno-adrenal shunt. Trop Gastroenterol. 2006, 27 (3): 136-7.PubMed

10.

Wright AS, Rikkers LF: Current management of portal hypertension. J Gastrointest Surg. 2005, 9 (7): 992-1005. 10.1016/j.gassur.2004.09.028.CrossRefPubMed

11.

Orloff MJ, Orloff MS, Rambotti M: Treatment of bleeding esophagogastric varices due to extrahepatic portal hypertension: results of portal-systemic shunt during 35 years. J Pediatr Surg. 1994, 29 (2): 142-151. 10.1016/0022-3468(94)90309-3.CrossRefPubMed

12.

Rosch J, Keller FS: Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World J Surg. 2001, 25 (3): 337-346. 10.1007/s002680020380.CrossRefPubMed

13.

Rikkers LF, Jin G, Burnett DA, Buchi KN, Cormier RA: Shunt surgery versus endoscopic treatment for variceal hemorrhage: Late results of randomized trial. Am J Surg. 1993, 165 (1): 27-33. 10.1016/S0002-9610(05)80400-3.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2482/7/7/prepub

Title: Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt
Authors: Unal Aydin
Pinar Yazici
Murat Kilic
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2007
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/1471-2482-7-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

Mirizzi syndrome type IV associated with cholecystocolic fistula: a very rare condition- report of a case

Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731]

Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DR ainage vs. (direct) OP eration (DROP-trial)

The influence of blood on the efficacy of intraperitoneally applied phospholipids for prevention of adhesions

The value of routine histopathological examination of appendicectomy specimens

Quality of life before surgical ICU admission