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Control of bleeding in extrahepatic portal hypertension — the reverse splenorenal shunt and portal‐azygos disconnection
Author(s) -
COHEN DOUGLAS,
STEPHEN MICHAEL
Publication year - 1984
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.1984.tb00065.x
Subject(s) - medicine , portal hypertension , shunt (medical) , surgery , portosystemic shunt , disconnection , azygos vein , portal venous pressure , splenectomy , spleen , cirrhosis , political science , law
Variceal bleeding in children with extrahepatic portal hypertension is best controlled by an effective decompressive shunt. Both the standard and central splenorenal shunts require splenectomy which is undesirable in childhood, and alternative shunts such as the mesocaval shunt and the distal splenorenal shunt are also technically difficult with a similar risk of shunt thrombosis. The reverse splenorenal shunt first described in 1962 by Erlik uses the proximal portion of the left renal vein which was initially anastomosed to the portal vein. It can be anastomosed to any of the major tributaries of the portal system. In the technique described, the proximal end of the renal vein is joined to the side of the splenic vein in continuity. It is preferable for this to be done as an elective planned procedure. Massive continuing haemorrhage which is not responding to conservative management can be controlled by portal‐azygos disconnection with gastric transection. This procedure will control major variceal haemorrhage for several years and allow a decompressive shunt to be performed under optimal conditions and after appropriate preoperative investigations.