Distal splenorenal (Warren) shunt following nephrectomy for renal cell carcinoma: case report

A 61-year-old man, who had previously undergone a mesocaval shunt for recurrent bleeding from esophageal varices secondary to portal hypertension and cirrhosis of the liver, experienced postoperative hemorrhage, again from esophageal varices. Angiographic evaluation of the thrombosed mesocaval shunt revealed an unanticipated left renal cell carcinoma, which was treated with radical left nephrectomy. The left renal vein was then anastomosed to the splenic vein, end-to-side fashion. The splenic vein was ligated at its junction with the superior mesenteric vein to affect a dital splenorenal (Warren) shunt. Pressure within the patient's splenic vein was reduced from 35 to 25 cm H2O. Grossly, and ultimately histologically, there was no evidence of tumor within the left renal vein. The patient made an uneventful recovery and has experienced no further bleeding from esophageal varices.