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Meso-Rex bypass to manage prehepatic portal hypertension after the failure of an intrahepatic portosystemic stent shunting

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Abstract

A cavernomatous transformation of the extrahepatic portion of the portal vein is a common cause of chronic portal hypertension in children. A few attempts at radiological interventions have been reported, but have rarely been successful. In this report, a surgical Meso-Rex bypass was performed to treat complicated prehepatic portal hypertension, after the insertion of an intrahepatic stent for portosystemic shunting had failed. The review of this case nicely illustrates how differently effective are these two shunting procedures—in terms of restoring hepatopetal flow, managing portal hypertension, and establishing—or not—portosystemic connections.

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Abbreviations

USD:

Ultrasound Doppler

PV:

Portal vein

CT:

Computed tomography

MR:

Magnetic resonance

TIPSS:

Transjugular intrahepatic portosystemic stent shunting

WBC:

White cells count

INR:

International normalised ratio

PTT:

Partial thromboplastin time

PT:

Prothrombin time

MRB:

Meso-Rex bypass

PHPH:

Prehepatic portal hypertension

PSS:

Portosystemic shunts

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Conflict of interests

All of the authors contributed to this analysis, and to the manuscript, at various degrees of assistance. All approved the final manuscript, and all agreed to be associated as authors. The authors declare no conflict of interest.

Ethical standards

This study was conducted retrospectively, with the consent of the patient’s family, and after the patient had been cared for, according to the standard rules of care, and in his best interest. Full information was given and a family consent was obtained, wherever it was necessary for the care. Because it was a retrospective collection of existing data, and because they were anonymised, no ethical committee approval was requested (as per the 1964 Declaration of Helsinki and its later amendments).

Author information

Correspondence to Jean de Ville de Goyet.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MPG 30308 kb)

Supplementary material 2 (MPG 29756 kb)

Supplementary material 3 (MPG 29546 kb)

Supplementary material 1 (MPG 30308 kb)

Supplementary material 2 (MPG 29756 kb)

Supplementary material 3 (MPG 29546 kb)

VIDEO ONLINE RESOURCES

ESM_1 Online Resource 1: Abdominal computer tomographic aspect, after thrombosis of the intrahepatic stent, and before the Meso-Rex Bypass (axial plane view).

ESM_2 Online Resource 2: Abdominal computer tomographic aspect, 4 years after the Meso-Rex Bypass (coronal plane view).

ESM_3 Online Resource 3: Abdominal computer tomographic aspect, 4 years after the Meso-Rex Bypass (axial plane view).

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di Francesco, F., Monti, L., Grimaldi, C. et al. Meso-Rex bypass to manage prehepatic portal hypertension after the failure of an intrahepatic portosystemic stent shunting. Pediatr Surg Int 31, 101–105 (2015) doi:10.1007/s00383-014-3640-5

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Keywords

  • Extrahepatic portal hypertension
  • Transjugular intrahepatic portosystemic shunt
  • Complications
  • Surgical technique
  • Meso-Rex bypass