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Mesocaval shunt: patency after 22 years--a case report
H Abu-Judeh1, P Bahramipour, K G Swan
1Department of Radiology, UMDNJ/NJMS, 185 South Orange Avenue, Newark, NJ 07103, USA.
Vascular Surgery
|October 5, 2001
Summary
A mesocaval shunt effectively controlled esophageal variceal bleeding in a cirrhosis patient for 23 years. The shunt remained patent, with the patient alive and well, experiencing minimal complications.
Area of Science:
- Hepatology
- Vascular Surgery
- Gastroenterology
Background:
- Portal hypertension secondary to Laennec's cirrhosis can cause life-threatening esophageal varices.
- Urgent intervention is sometimes required to manage severe gastrointestinal hemorrhage from these varices.
Observation:
- A 52-year-old man with Laennec's cirrhosis and alcoholism underwent urgent mesocaval shunt placement for esophageal variceal hemorrhage.
- The patient had no history of alcoholic hepatitis.
Findings:
- The mesocaval shunt remained angiographically patent 23 years post-procedure.
- The patient was alive and well with no hepatic encephalopathy, except for three episodes of gastrointestinal hemorrhage due to peptic ulcer disease.
- Hepatic coma episodes resolved promptly with conservative management (cathartics, enemas, lactulose) after bleeding cessation.
Implications:
- Mesocaval shunts can provide long-term patency and survival for patients with portal hypertension and esophageal varices.
- This case highlights the potential for durable outcomes with surgical management of variceal bleeding.
- Effective management of secondary complications like peptic ulcer disease is crucial for long-term patient well-being.