Splenoadrenal shunt. An original portosystemic decompressive technique

Management of gastrointestinal hemorrhage from rupture of esophageal and ga stric varices due to portal hypertension remains a debated question. In pat ients with sclerotherapy-resistant esophagogastric varices, and preserved h epatic function, a surgical shunt is considered the treatment of choice. A 63-year-old male was admitted in our Department with a diagnosis of idiop athic fibrosis of the liver, portal hypertension, esophageal and gastric va rices and previous history of variceal bleeding. A distal splenorenal shunt was planned. During the isolation, a large diameter left adrenal vein was identified. An end-to-end anastomosis utilizing the distal splenic vein and the proximal adrenal stump was performed. The procedure was uneventful. An ultrasound color Doppler on the 3rd postoperative day, showed normal intra splenic resistance index, demonstrating the efficacy of the shunt. A spleni c angiography carried out on the 8th postoperative day showed the complete patency of the splenoadrenal shunt. At the 15th postoperative day, the pati ent was discharged. In patients with portal hypertension, sclerotherapy-resistant esophagogastr ic varices and preserved hepatic function, a surgical portosystemic shunt i s mandatory. Splenoadrenal shunt, utilizing a left adrenal vein represent a n excellent option in selected cases.