Vasc Spec Int.  2020 Sep;36(3):186-192. 10.5758/vsi.200018.

Standard or Variant Meso-Rex Shunts for Children with Variceal Bleeding due to Extrahepatic Portal Vein Obstruction: A Report of Two Cases

Affiliations
  • 1Department of Surgery, Seoul National University Hospital, Seoul, Korea
  • 2Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 3Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

Abstract

Extrahepatic portal vein obstruction (EHPVO) is the most common cause of pediatric portal hypertension and can cause life-threatening variceal bleeding. MesoRex shunt (MRS) is a surgical procedure that restores physiological portal venous blood flow to the liver by using a graft to connect the superior mesenteric vein and the left portal vein within the Rex recess, and can relieve variceal bleeding and other complications associated with EHPVO. Although the MRS is regarded as an optimal and potentially curative treatment with good long-term patency, graft thrombosis or failure due to unknown causes is not rare, prompting the need for further research on the risk factors of graft failure or poor patency. Herein, we report two cases of EHPVO in patients with recurrent or uncontrolled variceal bleeding, one treated with the classic Rex shunt and the other with the modified Rex shunt, which resulted in a failure and success, respectively.

Keyword

Mesenteric venous thrombosis; Vascular grafting; Portal hypertension; Esophageal and gastric varices; Meso-Rex shunt
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