A Portal-Rex Shunt Using Patent Proximal Main Portal Vein as Venous Inflow and Internal Jugular Vein as Conduit

TL;DR

A new surgical technique for treating portal hypertension in children uses the internal jugular vein and a patent portal vein to create a successful shunt.

Contribution

A novel portal-Rex shunt technique using the internal jugular vein and proximal portal vein is proposed for extrahepatic portal vein obstruction.

Findings

Using the internal jugular vein as a conduit provided good patency and physiological response over one year.

A patent proximal portal vein can serve as an effective inlet for the portal-Rex shunt.

The shunt led to improved thrombocytopenia and reduced splenic size post-surgery.

Abstract

What are the main findings?

A proximal intact and patent portal vein may be an effective alternative inlet during surgery for a meso-Rex shunt.A portal-Rex shunt using an internal jugular vein as a conduit provided good patency and physiological response over a one-year follow-up.

A proximal intact and patent portal vein may be an effective alternative inlet during surgery for a meso-Rex shunt.

A portal-Rex shunt using an internal jugular vein as a conduit provided good patency and physiological response over a one-year follow-up.

What are the implications of the main findings?

Careful preoperative imaging of the residual splanchnic anatomy in extrahepatic portal vein obstruction (EHPVO) may reveal alternatives for a modification of the meso-Rex shunt.The availability of good-calibre intra-abdominal veins may avoid the need for neck exploration and associated morbidity.

Careful preoperative imaging of the residual splanchnic anatomy in extrahepatic portal vein obstruction (EHPVO) may reveal alternatives for a modification of the meso-Rex shunt.

The availability of good-calibre intra-abdominal veins may avoid the need for neck exploration and associated morbidity.

Background: Extrahepatic portal vein obstruction (EHPVO) accounts for more than two thirds of pediatric portal hypertension. Rex shunt is the preferred surgical management, as it restores hepatopetal flow and minimizes or reverses liver dysfunction. Case Summary: We report surgical treatment of EHPVO in a 9-year-old girl using portal-Rex shunt with internal jugular vein (IJV) as a conduit and the intact proximal main portal vein instead of the superior mesenteric vein as a venous inlet. Improvement in thrombocytopenia and reduction in splenic size were achieved post-operatively. The portal-Rex shunt remains patent with good hepatopetal flow at one year post-operation. Conclusions: The success of a portal-Rex shunt to selectively bypass EHPVO rests upon careful selection of inlet and outlet veins, as well as a conduit with good patency, such as the IJV.

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