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KMID : 0364019720050020107
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Korean Journal of Thoracic and Cardiovascular Surgery
1972 Volume.5 No. 2 p.107 ~ p.111
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A Case Report of Mesocaval Shunt in Failed Splenorenal Shunt
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鄭聖奎/Chung, Sung Kyoo
南敏祐/李浩一/柳會性/Nam, Min Woo/Lee, Ho Il/Yoo, Hoe Sung
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Abstract
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Recently we experienced a case of the portal hypertension, extralhepatic origin in the National Medical Center, Seoul.
The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceaI rupture 6 years later and had recurring esophageal varices with bleeding this time.
At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.
The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatively no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophageal variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.
Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again.
In this time, recurring esophageal varices was noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression, and following results were obtained.
1) No postoperative troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge.
2) During operation the portal pressure was 300 mm H₂O and immediately lowered to 170 mm H₂O after shunt.
3) The technic and operation time for this shunt was relatively easy and short: without any operative complication.
4) The anastomotic site was considerably large enough for effective portal decompression.
5) In case of failed previous shunt with bleeding like this patient, the mesocaval shunt is recommended as a good measure for portal decompression with excellcat results.
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