Multimodality imaging of the Meso-Rex bypass

Area of Science:

• Pediatric Gastroenterology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Extrahepatic portal vein obstruction (EHPVO) is the primary cause of upper gastrointestinal bleeding in children.
• EHPVO involves thrombosis of the extrahepatic portal vein, potentially extending intrahepatically.
• Portal hypertension is a significant complication of EHPVO.

Purpose of the Study:

• To highlight the importance of multimodality imaging in EHPVO diagnosis.
• To emphasize the role of imaging in identifying suitable candidates for Meso-Rex shunt surgery.
• To discuss the utility of imaging in detecting and managing complications post-Meso-Rex shunt.

Main Methods:

• Review of imaging modalities used for EHPVO diagnosis (e.g., ultrasound, CT, MRI).
• Correlation of imaging findings with surgical suitability for Meso-Rex bypass.
• Assessment of imaging for post-procedural complications.

Main Results:

• The Meso-Rex shunt is the preferred surgical treatment for EHPVO in children with appropriate anatomy.
• Successful shunting restores physiological portal reperfusion and resolves portal hypertension.
• Imaging is essential for pre-operative assessment and post-operative surveillance.

Conclusions:

• Radiologists must be proficient in imaging EHPVO and its treatment implications.
• Imaging guides patient selection for Meso-Rex shunt surgery, a definitive treatment for pediatric EHPVO.
• Interventional radiology can manage complications identified through imaging.