Transduodenopancreatic interposition mesocaval shunt using an internal jugular vein autograft

In 26 interposition mesocaval shunts using an internal jugular vein autograft which has been performed since 1970, four patients had important abnormalities in the superior mesenteric vein, making impossible the usual subduodenal position of the jugular vein graft. In these four patients, a small pancreatectomy was performed between the transverse portion of the duodenum and the right aspect of the superior mesenteric vein, placing the interposition mesocaval shunt in a transduodenopancreatic position. No patient has had any bleeding after the operation nor have esophageal varices been found at the time of the last examination. During this period, all patients showed a remarkable tolerance to proteins, so that no patient has been on a low protein diet.