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Left sided segmental portal hypertension following mesocaval interposition shunt
Surgery, Gynecology & Obstetrics
|August 1, 1977
Summary
Mesocaval interposition shunts for liver cirrhosis can lead to recurrent bleeding esophageal varices due to persistent lesser splanchnic venous hypertension. Splenectomy is recommended to address this complication and stop variceal hemorrhage.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Hepatology
Background:
- Esophageal varices are a serious complication of liver cirrhosis, often leading to life-threatening bleeding.
- Mesocaval interposition shunts are a surgical option to decompress the portal system and manage variceal bleeding.
Observation:
- Three patients undergoing mesocaval interposition shunts experienced recurrent esophageal varices or persistent portal hypertension.
- Angiographic and pressure studies revealed effective decompression of the greater splanchnic system but ongoing lesser splanchnic hypertension.
Findings:
- Altered mesenteric blood flow dynamics post-interposition shunt may cause gastrosplenic venous drainage to bypass the shunt.
- This diversion results in persistent lesser splanchnic venous hypertension, contributing to variceal recurrence.
Implications:
- The findings suggest a potential mechanism for shunt failure unique to mesocaval interposition shunts.
- Recognition of persistent lesser splanchnic hypertension is crucial for managing recurrent variceal bleeding.
- Splenectomy may be a necessary intervention in selected cases following mesocaval interposition shunts.