Objective To explore the feasibility of superior mesenteric vein-left portal vein bypass (Meso-Rex) using iliac arterial in the treatment of primary cavernous transformation of portal vein (CTPV). Methods The patient, female, 40 years old, was hospitalized due to dull pain in the upper abdomen for 4 weeks. Abdominal CT angiography showed CTPV, varicosity in the lower esophagus and fundus of stomach, and splenauxe. The admitting diagnosis was primary CTPV. Meso-Rex was performed using iliac artery from donation after cardiac death bridging between superior mesenteric vein and left intrahepatic portal vein. The patient was given heparin for anticoagulation therapy and was followed up by ultrasound after the operation. The informed consent of this patient were obtained and the local ethical committee approval was received. Results The operation was performed successfully. The blood flow of bypass vessel was good after operation, and no complication was observed. During 3 months follow-up, no thrombosis in the bypass blood vessel was observed. Conclusion Meso-Rex is a curative operation for CTPV, and has definite clinical effect. Iliac artery is safe and feasible when used as a shunt vessel. Giving active anticoagulant therapy to prevent thrombosis after operation is the key to success.