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Mesoportal bypass: a unique operation for mesenteric hypertension
F Silvestri1, H Dardik, R Vasquez
1Department of Surgery, Englewood Hospital and Medical Center, N.J. 07631, USA.
Journal of Vascular Surgery
|December 1, 1995
Summary
A rare case of gastrointestinal variceal bleeding caused by venous obstruction was successfully treated with a novel superior mesenteric vein-to-portal vein bypass. This procedure restored normal blood flow, preventing complications like hepatic encephalopathy.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Gastrointestinal variceal bleeding can be a serious complication of portal hypertension.
- Transjugular intrahepatic portal-systemic shunting (TIPS) is a common treatment for refractory variceal bleeding.
- Rare causes of venous obstruction can mimic or complicate portal hypertension.
Observation:
- A 47-year-old man presented with gastrointestinal variceal bleeding.
- Mesenteric arteriography revealed occlusion of the superior mesenteric, splenic, and inferior mesenteric veins.
- A mass at the superior mesenteric vein-splenic vein juncture, identified as suture material in fibrous tissue, was the cause.
Findings:
- The patient underwent a novel superior mesenteric vein-to-portal vein bypass using a prosthetic graft.
- Postoperative imaging confirmed graft patency and function.
- The procedure successfully decompressed the mesenteric circulation and facilitated hepatopetal blood flow.
Implications:
- This surgical approach offers a viable alternative for managing complex venous occlusive disease causing variceal bleeding.
- Direct bypass avoids the potential complications of TIPS, such as hepatic encephalopathy.
- Restoration of hepatopetal flow is crucial for maintaining liver function and preventing further complications.