Management of Extrahepatic Portal Vein Obstruction With Spleno-Adrenal Shunt

Abstract

Extrahepatic portal hypertension is the hypertension of the portal venous system in the absence of liver cirrhosis, and variceal bleeding is its commonly seen complication. Long-standing portal hypertension will have the risk of symptomatic hypersplenism, portal biliopathy, growth failure, and ectopic varices. Portosystemic shunt surgery can more effectively manage these complications than medical and endoscopic management. Conventional portosystemic shunts, especially the proximal splenorenal shunt (PSRS), are preferred over unconventional shunts, as the latter will have increased procedural complexities and increased postoperative morbidity. Though spleno-adrenal shunt (SAS) surgery is an unconventional type that offers an excellent alternative to PSRS with equal outcomes. Here, we present a case of a 21-year-old male who presented with a mass in the abdomen since childhood, with one episode of hematemesis. Upon thorough clinical examination, laboratory and radiological investigations made a diagnosis of extrahepatic portal hypertension with symptomatic hypersplenism, following which the patient underwent splenectomy, followed by SAS.

Keywords: extrahepatic portal hypertension; idiopathic portal hypertension; portal thrombosis; spleno-adrenal shunt; splenorenal shunt.

Figure 1. Coronal view of MRI of the abdomen showing massive splenomegaly (arrow mark).

Figure 2. (A) Intraoperative image showing the cut end of the splenic vein (yellow arrow) and dilated left adrenal vein (blue arrow). (B) Intraoperative image showing anastomosis between the splenic (end) and adrenal vein (side).