Ann Surg Treat Res.  2014 Feb;86(2):105-108. 10.4174/astr.2014.86.2.105.

Use of meso-Rex shunt with transposition of the coronary vein for the management of extrahepatic portal vein obstruction

• Cho YP
• Ha TY
• Ko GY
• Kim KM
• Lee SG

• KMID: 1908506
• DOI: http://doi.org/10.4174/astr.2014.86.2.105

Abstract

The meso-Rex shunt is used to safely and effectively treat patients with portal hypertension due to extrahepatic portal vein obstruction. In the standard meso-Rex shunt technique, the patient's own internal jugular vein is used as a vascular autograft. Inevitably, such a procedure requires neck exploration and sacrifice of the internal jugular vein. Here, we present a case of a 20-year-old man with idiopathic extrahepatic portal vein obstruction, who was treated with a new technique of transposition of the coronary vein, which is enlarged in most cases of portal hypertension, as an alternative to the standard meso-Rex shunt technique. The transposition of the coronary vein into the Rex recessus is more efficient and less invasive than harvesting an autologous vein graft. Therefore, this technique simplifies the procedure and should be used when possible.

Keyword

Portal vein; Obstruction; Meso-Rex shunt; Coronary vein; Technique

MeSH Terms

Autografts
Coronary Vessels*
Humans
Hypertension, Portal
Jugular Veins
Neck
Portal Vein*
Transplants
Veins
Young Adult

Figure

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  Fig. 1 (A, B) Preoperative axial and coronal reformatted computed tomography scan images showing an obliterated main (arrowhead) and left (open arrow) intrahepatic portal vein. Note the massively enlarged spleen (Sp).

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  Fig. 2 Operative findings showing the transposed coronary vein (white arrows) anastomosed end-to-side to the ventral portion of the extrahepatic left portal vein using nonabsorbable monofilament interrupted sutures.

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  Fig. 3 (A, B) Postoperative venogram of the splenic vein showing a brisk flow to the left intrahepatic portal vein (open arrows) via the meso-Rexshunt (arrowheads).

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  Fig. 4 (A-C) Axial and coronal reformatted computed tomography scan images at the 22-day follow-up showing increased portal flow (open arrows) via the preserved meso-Rex shunt (arrowheads).

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