Abstract
A 61-year-old man was referred to our hospital to treat extrahepatic portal venous obstruction. Endoscopic injection sclerotherapy (EIS) was performed for the esophageal varices; however, the patient returned with massive hematemesis from gastric varices 6 months after treatment. Although the varices were treated with EIS, gastric devascularization and splenectomy concomitant with shunt surgery were required to treat uncontrollable, frequent diarrhea and abdominal distension. Because the splenic vein, left gastric vein, left portal vein, and inferior vena cava were inadequate for anastomosis, an epiploic gonadal vein bypass was performed. The bypass graft remains patent 7 months after surgery, and the patient is in good health without any clinical symptoms. We describe a new bypass route for extrahepatic portal venous obstruction.
Highlights
Extrahepatic portal venous obstruction (EHPVO) is a disorder characterized by chronic blockage of portal venous flow that results in portal hypertension, and its associated elevated portal venous pressure leads to gastroesophageal variceal hemorrhage [1–4]
Several surgical shunts have been reported, and currently, mesenteric-left portal vein bypass (MLPVB) is the primary shunt used for EHPVO because it is the most physiologic shunt and it restores hepatic blood flow [5–10, 12]
We report a case of a severe adult-onset case of EHPVO in which epiploic gonadal vein bypass was effective
Summary
Extrahepatic portal venous obstruction (EHPVO) is a disorder characterized by chronic blockage of portal venous flow that results in portal hypertension, and its associated elevated portal venous pressure leads to gastroesophageal variceal hemorrhage [1–4]. Upper gastrointestinal endoscopy revealed linear varices without a red color sign from gastric cardia to the middle part of the esophagus, and endoscopic injection sclerotherapy (EIS) was performed He presented 6 months after the endoscopic. CT showed an occluded extrahepatic portal vein and markedly dilated left gastric vein (LGV) and mesenteric veins (Fig. 1). Because the patient’s activity of daily life was severely impaired by frequent diarrhea and abdominal distention and because the risk of rebleeding was high, gastric devascularization and splenectomy concomitant with shunt surgery was planned. The markedly dilated LGV and IVC were the candidates for the proximal and distal sites of the shunt, respectively, because the splenic vein (SpV) and LPV had become constricted and were inadequate for anastomosis (Fig. 1).
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