Intervention treatment such as balloon retrograde or anterograde transvenous obliteration has been used for management of refractory hepatic encephalopathy as well as gastric variceal bleeding. Recently, plug-assisted retrograde transvenous obliteration without a help of balloon was newly developed to treat these patients. Here, we report three cases suffering refractory hepatic encephalopathy who were treated with this new technique.
Balloon Occlusion ; Esophageal and Gastric Varices ; Hepatic Encephalopathy* ; Humans ; Portasystemic Shunt, Surgical ; Splenorenal Shunt, Surgical*

PURPOSE: To determine whether spontaneous a splenorenal shunt can be used as an imaging predictor of early renal hemodynamic changes in patients with cirrhosis. MATERIALS AND METHODS: The study included 82 cirrhotic patients and 41 control subjects. Three-phase CT was performed and CT attenuation values (Hounsfield units) of the renal cortex in three phases were measured to evaluate renal perfusion. Likelihood ratio tests for trend were conducted for age, presence of ascites, and Child's grade. RESULTS: The mean CT attenuation values of the renal cortex in cirrhotic patients were significantly lower than the values of control subjects in three phases: 153.3 +/- 37.9 versus 173.3 +/-25.2 in the arterial phase, 172.6 +/- 41.0 versus 197.6 +/- 26.5 in the portal phase and 136.9 +/- 26.0 versus 152.7 +/- 20.0 in the delayed phase, respectively. The mean CT attenuation value of cortices in patients with renal hypoperfusion was 119.9 +/- 11.8 in the portal phase. Child's class C (aOR: 58.4, 95% CI: 3.6-956.2; p < 0.01) and the presence of a renal shunt (aOR: 7.5, 95% CI: 1.8-30.5; p < 0.01) were associated with renal hypoperfusion. The incidence of renal hypoperfusion was associated with Child's grade (trend: p < 0.01), and not with the grade of ascites or age. CONCLUSION: A dilated spontaneous splenorenal shunt may be a risk factor for renal hypoperfusion in cirrhosis.
Ascites ; Fibrosis ; Hemodynamics ; Humans ; Incidence ; Liver ; Liver Cirrhosis ; Perfusion ; Risk Factors ; Splenorenal Shunt, Surgical

Pregnancy with liver cirrhosis and/or portal hypertension is uncommon. Additionally, pregnancy in young women who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis is extremely rare. Esophageal variceal rupture, fatal hemorrhage and epidural hematoma must be considered during the management of such patients. This is a case of epidural analgesia for labor in a patient who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis.
Analgesia, Epidural* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis* ; Liver* ; Pregnancy ; Rupture ; Splenorenal Shunt, Surgical*

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.
Humans ; Liver Cirrhosis ; diagnostic imaging ; Retrospective Studies ; Splenectomy ; Splenorenal Shunt, Surgical ; Ultrasonography

Chylous ascites is a rare condition caused by various diseases and conditions that interfere with the abdominal or retroperitoneal lymphatics, and uncommonly it can manifest as a post-operative complication after abdominal, retroperitoneal or mediastinal surgery. Chylous ascites can be diagnosed by a high triglyceride content in ascites. The authors experienced a 5-year-old girl with congenital hepatic fibrosis who presented with chylous ascites after a splenorenal shunt operation, who was successfully managed by fasting and total parenteral nutrition, followed by a lipid-free diet with medium chain triglyceride supplementation. Here, the authors report this case of post-operative chylous ascites after a splenorenal shunt (Warren shunt) operation with a review of the pertinent literature.
Ascites ; Child* ; Child, Preschool ; Chylous Ascites* ; Diet ; Fasting ; Female ; Fibrosis* ; Humans ; Parenteral Nutrition, Total ; Splenorenal Shunt, Surgical* ; Triglycerides

PURPOSE: To determine whether there is any difference in variceal distribution between patients with and without a history of esophageal variceal bleeding. MATERIALS AND METHODS: To compare the distribution of varices, abdominal CT scans of 24 patients with a history of esophageal variceal bleeding (hemorrhagic group) and 90 patients without a history of bleeding (non-hemorrhagic group) were retrospectively assessed. RESULTS: The most common varices in both the hemorrhagic (n = 21, 87.5 %) and nonhemorrhagic group (n = 53, 58.9 %) were coronary varices, with a statistically significant frequency (p < .01). Esophageal varices were also more common in the hemorrhagic than the nonhemorrhagic group (n=19, 79.2 % vs n = 36, 40.0 % : P < .005). Splenorenal shunts were more common in the nonhemorrhagic (n = 8, 8.9 %) than in the hemorrhagic group(n = 0, 0 %) (P < .05). Other types of varice such as paraumbilical (n = 10, 41.7 % vs n = 21, 23.3 %), perisplenic (n = 6, 25 % vs n = 15, 16.7 %) and retroperitoneal-paravertebral (n = 11, 45.8 % vs n = 24, 26. 7 %) were more common in the hemorrhagic group, but without a statistically significant frequency. CONCLUSION: The frequency of coronary and esophageal varices was significant in patients with a history of esophageal variceal bleeding. In patients without such a history, splenorenal shunts were seen.
Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal* ; Retrospective Studies ; Splenorenal Shunt, Surgical ; Tomography, X-Ray Computed ; Varicose Veins

During living donor liver transplantation, a large spontaneous splenorenal shunt (SRS) should be addressed to obtain adequate portal inflow. Various procedures such as direct ligation of the SRS, splenectomy, left renal vein ligation (LRVL), and renoportal anastomosis can be applied to treat a large SRS according to the hemodynamics of the portal flow and anatomic conditions. Of these surgical procedures, LRVL is a simple and effective solution for treatment of a large SRS. However, to perform a LRVL, rigorous evaluation of the recipient's anatomic and hemodynamic variations is mandatory. In the present case, we ligated the left renal vein to treat a large SRS, which resulted in an unexpected thrombosis of the left renal vein and remaining portal vein stenosis in the SRS. Therefore, we revised our decisions regarding whether the LRVL was properly applied.
Constriction, Pathologic ; Hemodynamics ; Humans ; Ligation* ; Liver Transplantation* ; Liver* ; Living Donors* ; Portal Vein ; Renal Veins* ; Splenectomy ; Splenorenal Shunt, Surgical* ; Thrombosis

End-stage liver disease is often accompanied by portal vein thrombosis (PVT) and large spontaneous splenorenal shunts (SRS). Recently, renoportal anastomosis (RP-A) of spontaneous splenorenal shunts in liver transplantation was reported as an effective method of portal vein reconstruction in cases of PVT with SRS. Here we report a successful case of RP-A in living donor liver transplantation (LDLT). A 46-year-old female with a large spontaneous splenorenal shunt and a portal vein thrombosis propagated to the superior mesenteric vein underwent living donor liver transplantation. At the operation, a side-to-end renoportal anastomosis was done using an interposing cadaveric iliac vein graft. Adequate portal venous blood flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. She has recovered well with normal graft function and renal function. Renoportal anastomosis for patients with large splenorenal shunts and expansive portal vein thrombosis to the superior mesenteric vein can be an effective and safe technique in patients PV thrombectomy.
Cadaver ; Female ; Humans ; Iliac Vein ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Mesenteric Veins ; Middle Aged ; Portal Vein ; Splenorenal Shunt, Surgical ; Thrombectomy ; Thrombosis ; Transplants

PURPOSE: To assess the safety and role of ligation of left renal vein (LRV) to avoid portal flow steal to the partial liver graft when living donor liver transplantation (LDLT) is performed for the cirrhotic patients with large spontaneous splenorenal shunt (SRS). METHODS: Between 2001 and 2005, 44 portal hypertensive patients with large SRS who underwent ligation of LRV were retrospectively reviewed. RESULTS: After ligation of LRV, thirty four patients of 44 pateints (77.3%) revealed hypo-attenuation of left kidney on computed tomography but 10 patients (22.7%) showed normal attenuation. Proteinuria and hematuria occurred in 22 patients (50%) and 43 patients (97.7%) respectively after operation, but nearly all of them recovered. Decreased urine outputs (less than 1,000 mL per day) appeared in 4 patients (9.1%), but disappeared after dialysis for 6+/-5.4 days. Serum creatinine increased in 43 patients (97.7%), but decreased to normal range in 40 patients (90.3%). During study period, portal flow steal to the liver graft did not occur after ligation of LRV, and liver regeneration was satisfactory. CONCLUSION: It seems to be a good graft salvage procedure for the portal hypertensive patients who demonstrate large SRS after partial liver engraftment.
Adult* ; Creatinine ; Dialysis ; Hematuria ; Humans ; Kidney ; Ligation* ; Liver Regeneration ; Liver Transplantation* ; Liver* ; Living Donors* ; Proteinuria ; Reference Values ; Renal Veins* ; Retrospective Studies ; Splenorenal Shunt, Surgical ; Transplants

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.
Duodenum ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hemorrhage* ; Humans ; Hypertension, Portal* ; Melena ; Portal Vein ; Prognosis ; Splenic Vein ; Splenorenal Shunt, Surgical ; Varicose Veins* ; Young Adult