Mesentericoportal Rex-shunt as a treatment for extrahepatic portal vein thrombosis

The most common cause of portal hypertension in children with healthy liver s is the prehepatic block. A 7-year-old girl had presented with portal vein thrombosis after umbilical vein catherization in the newborn period. She s uffered from collateral circulation with recurrent bleeding episodes due to esophageal varices (stage III-IV) and developed hypersplenism. Ultrasound demonstrated an open branch of the left portal vein. Direct splenoportograp hy showed an open and communicating superior mesenteric vein. Liver biopsy was normal. An autologous left jugular vein graft was used to create a bypa ss from the superior mesenteric vein to the umbilical portion of the left i ntrahepatic portal vein (mesentericoportal Rex-shunt). Postoperatively, nor mal intrahepatic portal vein flow was demonstrated by ultrasound. After 2 y ears of follow-up, the patient is asymptomatic with no signs of portal hype rtension. In contrast to classic portosystemic shunt operations, this bypas s restores physiological portal vein now, thus avoiding the possible conseq uences of longterm portosystemic shunting and low-grade encephalopathy.