MESOPORTAL BYPASS - A UNIQUE OPERATION FOR MESENTERIC HYPERTENSION

Citation
F. Silvestri et al., MESOPORTAL BYPASS - A UNIQUE OPERATION FOR MESENTERIC HYPERTENSION, Journal of vascular surgery, 22(6), 1995, pp. 764-768
Citations number
19
Categorie Soggetti
Surgery,"Cardiac & Cardiovascular System","Peripheal Vascular Diseas
Journal title
ISSN journal
07415214
Volume
22
Issue
6
Year of publication
1995
Pages
764 - 768
Database
ISI
SICI code
0741-5214(1995)22:6<764:MB-AUO>2.0.ZU;2-S
Abstract
A 47-year-old man was referred for evaluation and treatment of gastroi ntestinal variceal bleeding and possible transjugular intrahepatic por tal-systemic shunting. Intrahepatic manometry disclosed a normal porta l pressure, but selective mesenteric arteriography revealed occlusion of the superior mesenteric, splenic, and inferior mesenteric veins. Du odenal and gastric varices were noted, but no esophageal varices were seen. The portal vein was clearly patent. At surgery, a 2 cm mass was found at the superior mesenteric vein-splenic vein juncture, and subse quent pathologic examination confirmed the presence of suture material within dense fibrous tissue as the probable cause for this rare condi tion. The surgical procedure performed was a superior mesenteric vein- to-portal vein bypass, employing ringed expanded polytetrafluoroethyle ne. Graft patency and function have been confirmed postoperatively by means of both venous-phase mesenteric arteriography and duplex imaging . The surgical procedure was novel, in that it was possible to decompr ess the hypertensive mesenteric circulation from the distal superior m esenteric vein directly into the portal vein with a prosthetic bypass. The physiologic benefit of this operation is clear: the avoidance of the encephalopathic syndrome and the facilitation of hepatopetal blood flow.