PORTOPULMONARY SHUNT BY SPLENOPNEUMOPEXY AS A TREATMENT FOR PORTAL-HYPERTENSION DUE TO EXTRAHEPATIC PORTAL-VEIN OBSTRUCTION - CASE-REPORT

A case of secondary portal hypertension due to extrahepatic portal vei n obstruction that was treated by splenopneumopexy approximately nine years ago is presented. The patient was a forty-seven-year-old man suf fering from hematemesis. On preoperative portography, the portal trunk could not be visualized, and cavernous transformation of the portal v ein and moderate esophageal varices were demonstrated. Splenopneumopex y for management of esophageal varices was accomplished as treatment. After the operation, significant portopulmonary shunt was developed an d findings of the esophageal varices were improved. Results from pulmo nary and hepatic function tests after operation were essentially uncha nged. For nine years since the operation he has had no episode of recu rrent variceal bleeding. Splenopneumopexy, which diverts the portal bl ood into the pulmonary vein, is one of the shunt procedures used as tr eatment for portal hypertension. In Japan, endoscopic sclerotherapy is the first choice of treatment for variceal bleeding. However, splenop neumopexy is still useful as a treatment for patients with secondary p ortal hypertension such as extrahepatic portal vein obstruction.