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Case Reports
. 2020 Sep 30;36(3):186-192.
doi: 10.5758/vsi.200018.

Standard or Variant Meso-Rex Shunts for Children with Variceal Bleeding due to Extrahepatic Portal Vein Obstruction: A Report of Two Cases

Moon Young Oh  1 , Hyo Kee Kim  2 , Ahram Han  2 , Nam-Joon Yi  3 , Seung-Kee Min  2
Affiliations
Case Reports

Standard or Variant Meso-Rex Shunts for Children with Variceal Bleeding due to Extrahepatic Portal Vein Obstruction: A Report of Two Cases

Moon Young Oh et al. Vasc Specialist Int. .

Abstract

Extrahepatic portal vein obstruction (EHPVO) is the most common cause of pediatric portal hypertension and can cause life-threatening variceal bleeding. Meso- Rex shunt (MRS) is a surgical procedure that restores physiological portal venous blood flow to the liver by using a graft to connect the superior mesenteric vein and the left portal vein within the Rex recess, and can relieve variceal bleeding and other complications associated with EHPVO. Although the MRS is regarded as an optimal and potentially curative treatment with good long-term patency, graft thrombosis or failure due to unknown causes is not rare, prompting the need for further research on the risk factors of graft failure or poor patency. Herein, we report two cases of EHPVO in patients with recurrent or uncontrolled variceal bleeding, one treated with the classic Rex shunt and the other with the modified Rex shunt, which resulted in a failure and success, respectively.

Keywords: Esophageal and gastric varices; Mesenteric venous thrombosis; Meso-Rex shunt; Portal hypertension; Vascular grafting.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Preoperative computed tomography scan showing a cavernous formation around the porta hepatis (arrow in A) and portal vein thrombosis (arrow in B).
Fig. 2
Fig. 2
Computed tomography scan on the second postoperative day showing a thrombosed internal jugular vein graft.
Fig. 3
Fig. 3
Intraoperative portal venogram showing a patent right portal vein (white arrow). However, only the main left portal vein is opacified without showing its branches (black arrow).
Fig. 4
Fig. 4
Preoperative computed tomography scan showing a cavernous formation around the porta hepatis (A) and portal vein thrombosis (B).
Fig. 5
Fig. 5
Intraoperative findings showing the procedure of the modified coronary vein-left portal vein (LPV) shunt. (A) Coronary vein isolation. (B) LPV isolation. (C) Distal end-to-end anastomosis of the great saphenous vein (GSV) graft to the LPV. (D) Proximal end-to-end anastomosis of the coronary vein to the GSV graft.
Fig. 6
Fig. 6
Intraoperative Doppler ultrasonography image showing no left portal vein flow during clamping (A) but showing active flow after the anastomosis (B).
See this image and copyright information in PMC

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