Splenorenal Shunt Research Articles

H-shaped partial splenorenal shunting with the use of a reinforced graft made of porous polytetrafluoroethylene.

The study was aimed at improving the immediate and remote results of splenorenal bypass grafting. A total of 57 patients presenting with hepatic cirrhosis, portal hypertension, and recurrent haemorrhage from oesophageal varices underwent an H-shaped partial splenorenal shunt procedure using an externally reinforced 1.5-2.0-cm-long synthetic graft with a diameter equalling half of that of the splenic vein in an end-to-side fashion. Assessment of efficacy of shunting was based on intraoperative measurement of venous pressure in the portal system before and after shunting, the findings of Doppler ultrasonography of the linear velocity of blood flow in the portal, splenic, and left renal veins in the early postoperative period, as well as computed tomography, esophagogastroscopy, and assessment of the degree of hepatic encephalopathy in the remote postoperative period. The findings of intraoperative measurement of venous pressure in the portal vein system before and after shunting demonstrated a statistically significant decrease in (normalization of) portal pressure in all patients after bypass grafting (p≤0.05). There were no severe postoperative complications, in-hospital mortality, nor events of decompensation of hepatic insufficiency. According to the findings of Doppler ultrasonography of the linear velocity of blood flow and control computed tomography after surgery, the splenic vein, left renal vein and the conduit between them remained patent at all terms of postoperative follow up. The findings of control esophagogastroscopy revealed a statistically significant decrease in the degree of oesophageal varices at 3, 6, and 9 months after shunting (p≤0.05). There was no statistically significant difference in the change of the degree of hepatic encephalopathy at 3, 6, and 9 months after shunting (p=0.853, p=0.712, and p=0.581, respectively). At various terms after surgery, nine patients underwent deceased donor liver transplantation, with the splenorenal shunt ligated intraoperatively. This method of splenorenal shunting makes it possible to decrease the risk of bleeding from oesophageal varices and venous thromboses in vascular anastomoses, as well as complications resulting from using autovenous conduits, to decrease the risk of decomposition of hepatic insufficiency and the frequency of the development of encephalopathy in the postoperative period. Besides, this method makes it possible to easily dismantle the previously created artificial portocaval shunt in the process of liver transplantation.

Portal Cavernoma Complicating a Persistent Postoperative Bile Leak after Liver Hydatid Cyst Surgery: -a Report Case-

INTRODUCTION: Hydatid cyst is a parasitic infection caused by the larval form of Echinococcus granulosis. Portal hypertension is an unusual postoperative complication after a liver hydatid cyst surgery. CASE PRESENTATION: To illustrate this rare condition, we present the case of a 32-year-old patient operated for a liver hydatid cyst with late-onset postoperative complications. The patient suffered from secondary digestive bleeding because of portal hypertension and was therefore treated with a distal splenorenal shunt (Warren). CONCLUSION: Surgery of hydatid cyst may cause severe complications like portal hypertension and in certain cases, distal splenorenal anastomosis might represent an important treatment option that needs to be performed in specialised centres. Keywords: Liver cyst, Portal hypertension, Splenorenal shunt.

Advances in research of spontaneous splenorenal shunt in patients with liver cirrhosis

Advances in research of spontaneous splenorenal shunt in patients with liver cirrhosis

Distal Splenorenal Shunt (DSRS) in Children with Extrahepatic Portal Hypertension.

Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.

Outcome of portosystemic shunt surgery on pre-existing cholangiopathy in children with extrahepatic portal vein obstruction.

This study was performed to assess the effect of portosystemic shunt surgery (PSS) on portal cavernoma cholangiopathy (PCC) in children with extrahepatic portal veinobstruction (EHPVO). Children with EHPVO and PCC (unfit for Meso-Rex shunt) underwent magnetic resonance cholangiogram (MRC) and magnetic resonance portovenogram (MRPV) before non-selective PSS. PCC was graded by modified Llop classification. Those with patent shunt were re-evaluated at least 6months after surgery with MRC, MRPV and compared with pre-shunt images. Twenty-five children underwent PSS (central end to side splenorenal shunt with splenectomy [n=24], mesocaval shunt [n=1]). Pre-surgery MRC showed PCC grade I in 11, grade II in 1 and grade III in 13. MRPV showed superior mesenteric vein (SMV)block in 20. Re-assessment for PCC 18 (6 to 54) months after surgery showed grade I in 6 and grade III in 19. Thus, PCC was progressive in 6 and static in 19. Density of peribiliary collaterals decreased in 5 (SMV patent, static PCC), increased in 3 and remained unchanged in 17. Splenomegaly-related problems, gastroesophageal varices and other intra-abdominal (esophageal, perisplenic and perigastric) collaterals ameliorated in all. Non-selective PSS decompresses esophago-gastro-splenic venous circuit effectively but fails to ameliorate cholangiopathy and peribiliary collaterals. Persistence of cholangiopathy is attributable to SMV block.

A Rare Case of Hemorrhagic Shock: Perisplenic Varices with Large Splenorenal Shunt Treated by Balloon-Occluded Retrograde Transvenous Obliteration.

A Rare Case of Hemorrhagic Shock: Perisplenic Varices with Large Splenorenal Shunt Treated by Balloon-Occluded Retrograde Transvenous Obliteration.

346 Loop Combined Endoscopic Clip and Cyanoacrylate Injection to Treat the Severe Gastric Varices With Spleno-Renal Shunt

INTRODUCTION: Endoscopic cyanoacrylate injection has been successfully used in the management of gastric variceal bleeding and recommended as firest line treatment in China. However, one of the most severe complications such as systemic embolism is fatal, especially for the gastric varice with a huge shunt. With the aim of reducing the risk of embolization, we here report on the use of a loop combined an endoscopic clipping prior to cyanoacrylate injection as a therapy to obstruct gastric varices with a large slpeno-renal shunt. CASE DESCRIPTION/METHODS: A 53-year-old woman was admitted with gastrointestinal hemorrhage a week ago, who underwent the subtotal gastrectomy and Billroth-II anstomosis because of obscure hemorrhage shock 18 years ago. Physical examination showed spleen was touched 4 cm below the rib cage. Lab test showed red blood cell, white blood cell and platelet were all decreased. Upper endoscopy revealed a large gastric fundal varix about 12 mm diameter and computed tomography (CT) scan showed a massive spleno-renal shunt and cavernous transformation of the portal vein (Figure 1). The prophylactic endoscopic therapy was performed for recurrent bleeding. According to the CT scan, we assessed the shunt direction from gastric fundal to cardia. A clip fixed on the middle of the varix as a pivot, a loop encircled the afferent branch and tightened up the loop gradully to obstruct the partial blood flow, simultaneously sucking slowly. After released the loop, a mixture (including 2 ml lauromacrogol, 1 ml cyanoacrylate and 2 ml sodium chloride solution) was injected into the circled vein to break further the blood flow. Then 3 mixtures were injected into the afferent vein and 1 mixture was injected into the efferent vein at different point separately to block thoroughly. One week later, upper endoscopy showed the gastric fundal varix were obstructed and CT showed the huge spleno-renal shunt were also breaking (Figure 2). Moreover, no systemic embolism was occurred. No bleeding was happened during the 6-week follow-up period. 3 month and a half year later, endoscopy view showed the fundal varix gradually disappeared and CT scan showed the varix solidified (Figure 3). DISCUSSION: In this case, we used a novel method which is a loop combained an endoscopic clipping to block the main stem of huge isolated gastric varice and cut back the cyanoacrylate injection. It suggested that this new way could operate more easier and simpler, avelliate the fatal embolism. More importantly, for patients, they can pay less cost. Watch the video: http://bit.ly/2Z4ivXq

1970 Spontaneous Page Kidney as a Cause of Gastric Variceal Bleed

INTRODUCTION: Gastric variceal bleeding occurs in 15–50% of patients with non-cirrhotic portal venous thrombosis but can also occur in cases of splenic vein thrombosis (SVT) due to the formation of isolated gastric varices (IGV). We present the first reported case of a page kidney causing splenic vein compression, thrombosis, and subsequent gastric variceal bleeding. CASE DESCRIPTION/METHODS: A 31-year-old stuntman presented with epigastric pain and worsening exertional dyspnea over 3 weeks. History was notable for melena and anemia with no reported ulcers on endoscopy. On admission, he had hemoglobin of 4.1 g/dl with severe iron deficiency and elevated reticulocyte count. There was no serologic evidence of hepatic or renal disease. A computed tomography (CT scan) of the abdomen revealed a large left-sided perirenal collection consistent with page kidney, splenomegaly and decreased caliber of the mid and distal splenic vein suggestive of nonocclusive SVT. His liver was normal. Initial endoscopy revealed an IGV type 1 and mild portal hypertensive gastropathy (Figure 1). CT angiography did not reveal a splenorenal shunt to pursue a balloon retrograde transvenous obliteration (BRTO). While admitted, he developed hematemesis and worsening anemia. Ultimately, underwent IR splenic vein stenting with a bare-metal stent and subsequent decompression of the gastric varices with brisk flow of the portal vasculature (Figure 2). DISCUSSION: Gastric varices are classified primarily by location with most involving the gastroesophageal junction due to portal hypertension. The incidence of bleeding is highest in IGV, typically associated with SVT. Common etiologies of SVT include pancreatitis, malignancy or trauma. Our case described an extrinsic splenic vein compression and subsequent thrombosis due to a sub-capsular renal hematoma possibly of unclear etiology. Treatment for GV often depends on local expertise, but commonly consists of cyanoacrylate injection, banding (especially in type 1 gastro-esophageal varices), transjugular intrahepatic portosystemic shunt (TIPS) placement, BRTO, and even splenectomy. More recently, in cases of IGV due to isolated SVT, splenic vein stenting has been increasingly utilized. In our case, TIPS would not address the pre-hepatic portal hypertension and cyanoacrylate was not available. Splenic vein stenting was thus chosen to decompress the IGV with excellent response seen on subsequent follow-up (Figure 1).

Results of portosystemic shunts during extended pancreatic resections.

Patients with borderline resectable pancreatic cancer are increasingly explored after neoadjuvant treatment protocols. A complete resection, then, frequently includes the resection of the mesentericoportal axis. Portosystemic shunting for advanced tumours with infiltration of the splenic vein or cavernous transformation of the portal vein can enable complete tumour resection and prevent portovenous congestion of the intestine. The aim of this study was to report the results of this technique for selected patients. Patients operated for pancreatic cancer at our department between September 2012 and December 2017 using intraoperative portosystemic shunting were included in this retrospective analysis. Some 11 patients with pancreatectomy and simultaneous portosystemic shunting were included. The median age was 65.1years. A distal splenorenal shunt and a temporary mesocaval shunt were accomplished in 5 and 4 cases, respectively. Two patients were operated using persistent mesocaval shunts (from the coronary, splenic or inferior mesenteric veins). The median operating time was 9.43h. All but one patient were resected with tumour-negative resection margins; 5 patients had relevant complicated postoperative courses. There was one case of in-hospital mortality but no further 30- or 90-day mortality or graft-associated complications. Five patients were alive after a median follow-up of 24.6months. The median postoperative survival was 12months. Portosystemic shunting at the time of extended pancreatectomy is technically challenging but feasible and enables complete tumour resection in cases in which standard vascular reconstruction is limited by cavernous transformation or to prevent sinistral portal hypertension with acceptable morbidity in selected cases. Considering the limited overall survival, the potential individual patient benefit needs to be weighed against the considerable morbidity of advanced tumour resections.

Intrahepatic Portosystemic Shunt in a Young Female: Views from a Developing Country.

A young female presented to us with abdominal distension along with pedal edema. She had no prior medical or surgical history apart from a caesarean section done a few years prior. Initial workup showed low hemoglobin, low serum albumin and slight raised ESR. Her LFTs were slightly deranged. Ultrasound abdomen had evidence of portal hypertension along with splenomegaly. While ultrasound hepatic Doppler revealed a portosystemic shunt between the portal vein and the left hepatic vein, with a shunt ratio of 7.1%. CT scan abdomen confirmed these findings and a diagnosis of Type III intrahepatic portosystemic shunt and spleno-renal shunt was made. Since the patient was currently asymptomatic, she was advised regular follow-ups and was managed conservatively.

A case of refractory hepatic encephalopathy successfully treated with simultaneous balloon-occluded retrograde transvenous obliteration of mesocaval and splenorenal shunt

A case of refractory hepatic encephalopathy successfully treated with simultaneous balloon-occluded retrograde transvenous obliteration of mesocaval and splenorenal shunt

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

PVT is the most frequent vascular complication after LT in small children, and a higher incidence has been observed in those transplanted for biliary atresia or with a LLSG. Thrombosis of the PV causes extrahepatic portal hypertension and is associated with splenomegaly and the development of venous neo-collaterals, including gastro-oesophageal varices and splenorenal shunts. It has also been incidentally suggested in the literature that patients who have had a Roux-en-Y loop for a biliary reconstruction may present with a cavernomatous transformation of the distal portion of the loop. In this study, 13 children with CEPH caused by thrombosis of the PV after LT were analysed. The study evidenced the development of two types of hepatopetal venous networks: (a) a large cavernoma along the Roux loop and around the biliary anastomosis, and (b) a network of neo-collaterals in the gastro-duodeno-pancreatic area that connected to the intrahepatic portal branches directly through the liver capsule. These hepatopetal venous networks between the venous system of the surrounding organs or the omentum and the intrahepatic portal branches can be identified by radiologists. The relevance for the transplanting physician and the transplant surgeon is discussed.

The role of surgical shunts in the treatment of pediatric portal hypertension

BackgroundPortal diversion by surgical shunt plays a major role in the treatment of medically refractory portal hypertension. We evaluate our center’s experience with surgical shunts for the treatment of pediatric portal hypertension. MethodsAll patients who underwent surgical shunt at a single institution from 2008 to 2017 were reviewed. The primary outcome was intervention-free shunt patency. ResultsIn this study, 34 pediatric patients underwent portal shunt creation. The median age was 7.7 years (interquartile range 4.3–12.0). Twenty-nine patients (85%) had prehepatic portal hypertension and 5 patients (15%) had intrahepatic portal hypertension. The primary manifestations of portal hypertension were esophageal varices (97%) and gastrointestinal bleeding (77%). Eighteen patients (53%) underwent meso-Rex bypass, 10 patients (29%) underwent splenorenal shunt, and 6 patients (18%) underwent mesocaval shunt. Outcomes were notable for minimal wound complications (9%), rebleeding events (12%), and mortality (3%). In the postoperative setting, 10 patients (29%) experienced a shunt complication (occlusion or stenosis), 4 of which occurred in the early postoperative period and required urgent intervention. The 1-year and 5-year “primary patency” patency rates were 71% and 66%, respectively. ConclusionChildren suffer significant morbidity from the sequelae of portal hypertension. Our experience reinforces the feasibility of surgical shunts as an effective treatment option associated with low rates of morbidity and mortality.

Endovascular treatment of surgical mesoportal and portosystemic shunt dysfunction in pediatric patients

Published data describing the endovascular treatment of dysfunctional mesoportal and portosystemic shunts in the pediatric population are limited. We sought to describe the treatment and follow-up of such shunts managed by interventional radiology at a single pediatric hospital. We hypothesized that stenotic and occluded pediatric portosystemic and mesoportal shunts can be maintained patent by interventional radiology in the moderate term. We conducted a single-center retrospective study at a tertiary pediatric hospital. We included children with surgical mesoportal (meso-Rex) or portosystemic (mesocaval, splenorenal or splenocaval) shunts treated with attempted angioplasty or stenting from 2010 to 2018. Technical success was defined as catheterization and intervention upon the shunt with venographic evidence of flow improvement. The primary outcome variables were shunt patency at 1month, 6months, 12months and 24months post-procedure and freedom from reintervention. Twenty pediatric patients (11 boys, 9 girls; mean age 8.25years, range 1.3-17years) met inclusion criteria. Fifty-two interventions (primary and reintervention) on 13 splenorenal, 3 meso-Rex, 2 mesocaval and 2 splenocaval shunts were performed because of evidence of shunt failure, including gastrointestinal bleeding, hypersplenism, or radiographic evidence of a flow defect. The 11 stenotic shunts were treated with 100% technical success, while the remaining 9 occluded shunts were treated with 66.7% technical success. The mean number of reinterventions was 1.9 (standard deviation [SD] = 3.1) per child, which did not differ between stenotic and occluded shunts (P=0.24). Primary patency at 1-month, 6-month, 12-month and 24-months follow-up visits was 17/17 (100%), 10/16 (62.5%), 7/15 (46.7%) and 4/10 (40%), respectively. However, 100% of shunts were either primary patent or primary-assisted patent by endovascular reintervention. There were no cases of shunt occlusion following initial technical success. Finally, the median freedom from reintervention duration was 387days (SD=821days). Dysfunctional portosystemic surgical shunts are effectively managed by endovascular methods. While many shunts require reintervention, combined primary patency and assisted primary patency rates are excellent.

062 Alcohol associated toxic myelopathy with normal hepatic function

IntroductionAlcohol related neurological dysfunction affects the central and peripheral nervous system. We present a rare consequence of excessive alcohol consumption. A 42-year-old female consuming 2 bottles of wine daily for the preceding 5 years presented with 12 months of progressive gait disturbance. Examination revealed a spastic paraparesis with prominent dorsal column signs. Extensive work up found no alternate cause for her presentation. The final diagnosis was direct alcohol mediated toxic myelopathy. We reviewed the current literature on this rare condition.MethodsWe searched PubMED/OVID databases with the terms ‘alcohol AND myelopathy’.ResultsThere is a paucity of research on this clinical entity. Sage et al.1 described 5 well-nourished alcoholics presenting with a progressive myelopathy. As with our patient, routine laboratory tests, including nutritional screen, were normal. CT Myelogram revealed no structural cause. CSF was normal. In contrast, a myelopathic syndrome can occur in alcoholic hepatic failure, attributed to portosystemic shunting of blood, with resultant hyper-ammonaemia and demyelination of corticospinal tracts.2–4ConclusionAlcohol associated toxic myelopathy is a rare entity, distinct from hepatic myelopathy. It is thought to result from direct toxic effects of ethanol on corticospinal and large myelinated sensory tracts. The sensory involvement is unique for this entity, which distinguishes it from hepatic myelopathy, where corticospinal involvement predominates. It is prudent to look for other potentially treatable secondary causes of myelopathy. Abstinence from alcohol results in modest improvement in symptoms. Minimal literature exists on this clinical entity and further research is required.ReferencesSage JI, et al. Alcoholic myelopathy without substantial liver disease. A syndrome of progressive dorsal and lateral column dysfunction. Arch Neurol. 1984 Sep;41(9):999–1001.Premkumar M, et al. Hepatic Myelopathy in a Patient with Decompensated Alcoholic Cirrhosis and Portal Colopathy. Volume 2012, Article ID 735906, 4 pages.Koo JE, et al. Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt. Korean J Hepatol. 2008 Mar;14(1):89–96.Kori P, et al. Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis. BMJ Case Rep. 2013; 2013: bcr2013009078.

A preliminary study on predicting anastomotic occlusion in patients with cirrhosis underwent splenectomy combined with splenorenal shunt by ultrasonography

To predict anastomotic occlusion after splenectomy combined with splenorenal shunt surgery by ultrasound technique. Methods: To retrospectively analyze 53 cases of splenectomy combined with splenorenal shunt surgery. We divided these patients into 2 groups: a patency group (n=39) and an occlusion group (n=14), which were based on the results of splenorenal venous anastomotic stoma with spiral CT. The statistical methods were used to analyze the ultrasound detection indicators (the internal diameter, blood flow velocity, blood flow volume, thrombosis and blood flow direction of portal vein, splenic vein, and superior mesenteric vein) for those 2 groups, and then to figure out the predictive factors that affect splenorenal venous anastomotic stoma. Results: Compared with the patency group, there are significant broadening of the portal vein diameter, narrowing of the splenic vein diameter, reduction of the splenic vein blood flow velocity, reduction of splenic venous flow volume, splenic vein thrombosis formation and changes of the splenic vein blood flow direction (all P<0.05). Conclusion: Ultrasound indicators of portal vein diameter broadening, splenic vein diameter narrowing, splenic vein blood flow velocity reduction, splenic venous flow volume reduction, splenic vein thrombosis formation and change of splenic vein blood flow direction are influential factors for the splenorenal anastomotic occlusion in patients after splenectomy combined with splenorenal shunt surgery.

Acute hyperammonemic encephalopathy due to a portosystemic shunt in a non-cirrhotic adult patient

ObjectiveTo report a successfully treated hyperammonemia due to a portosystemic shunt in adult patient. Data sourceA patient with an altered mental status due to severe elevated ammonia level because of a portosystemic shunt. ConclusionsHyperammonemia is not always related to liver failure in critically ill patients, but should be considered in all unknown origins of an altered mental status. A portosystemic shunt can be the responsible for this phenomenon, and it has a newly treatment technique named plug-assisted retrograde transvenous obliteration (PARTO), which can be quickly performed with high technical success rate and clinical efficacy for the treatment of the splenorenal and/or gastrorenal shunt.

Adjuvant Transjugular Variceal Occlusion at Creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS): Efficacy and Risks of Bucrylate Embolization

The retrospective study evaluated 104 of 237 cirrhotic patients with TIPS for variceal bleeding who received adjuvant bucrylate embolization. For TIPS creation, bare stents were used in 35 patients (33.7%) and covered stents in 69 patients (66.3%) patients. Isolated gastric varices were seen in 10 patients (9.6%). Six patients (5.8%) rebled during a median follow-up time of 26months (1-57months). Rebleeding occurred in 14% (5/35) of patients with a bare stent but only in 1.4% (1/69) of patients with a covered stent. The 1- and 2-year rebleeding rates of all patients were 0.9 and 2.9% and of patients receiving a bare stent were 2.9 and 8.6%, respectively. Bucrylate migration was seen in 13 patients (12.5%). In 9 of these patients (8.7%), asymptomatic lung embolization occurred. This was rare in patients with esophageal varices (3.1%) but frequent (60%) in patients with isolated gastric varices and a spontaneous splenorenal shunt. Our results suggest that adjuvant embolization using bucrylate is effective and delays variceal rebleeding. The general use of covered stents, however, alleviates the utility of adjuvant bucrylate embolization which may be restricted to patients with a high risk of rebleeding indicated by large varices, active, acute or recent variceal bleeding and advanced cirrhosis. Bucrylate should not be used in isolated gastric varices because it bears a high risk of migration into the lungs.

Cystic fibrosis and portal hypertension: Distal splenorenal shunt can prevent the need for future liver transplant

BackgroundThe management of portal hypertension (PHT) in children with well compensated cirrhosis and cystic fibrosis (CF) is controversial. We present our experience with distal splenorenal shunting (DSRS) for the treatment of PHT as an alternative to liver transplantation (LT). MethodsBetween 2008 and 2017, 5 CF children underwent a DSRS at a pediatric hepatobiliary and transplantation referral center. LT (n = 9) was reserved for patients with decompensated cirrhosis. Statistical analysis was done using the paired t-test (p < 0.05 considered significant). ResultsMean PELD/MELD score was significantly lower for DSRS patients than LT (3 ± 6 vs 28 ± 4, p < 0.001). All 5 DSRS patients had grade III–IV varices. One bled prior to surgery. After DSRS, spleen size decreased significantly from 8.4 ± 1.5 cm to 4.4 ± 1.8 cm (p = 0.019). Mean platelet count remained stable (87.8 ± 48 to 91.8 ± 35, p = 0.9). There were no postoperative complications. No DSRS patient experienced variceal bleeding following shunt creation. Liver function tests remained stable in the DSRS group, and no patient required a liver transplant (median follow up 4.65 years, range 1.24–7.79). ConclusionsPatients with cystic fibrosis who have well-compensated cirrhosis and symptomatic portal hypertension can be palliated with distal splenorenal shunting and do not need liver transplants. These patients can undergo shunting with minimal morbidity. Type of studyCase series with no comparison group. Level of evidenceIV.

A case of renal artery and multiple splenic artery aneurysms managed by heterotopic renal autotransplantation with splenectomy and proximal splenorenal shunt

A 30-year-old female was incidentally detected to have multiple splenic artery aneurysms and a large left renal artery aneurysm along with portal hypertension and splenomegaly during her prenatal workup. She was successfully managed by splenectomy, proximal splenorenal shunt, excision of left renal artery aneurysm, bench reconstruction of the left renal artery with saphenous vein graft, and renal autotransplantation in the right iliac fossa.