Revision of meso-Rex bypass utilizing a collateral vein in a patient with portal steal phenomenon after liver transplant: A case report
| العنوان: | Revision of meso-Rex bypass utilizing a collateral vein in a patient with portal steal phenomenon after liver transplant: A case report |
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| المؤلفون: | Linda S. Book, Fidel Lopez-Verdugo, Ruben Blachman-Braun, Diane Alonso, G. Peter Feola, Manuel I. Rodriguez-Davalos |
| المصدر: | International Journal of Surgery Case Reports |
| بيانات النشر: | Elsevier BV, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Pediatric liver transplantation, Culprit, Article, 03 medical and health sciences, 0302 clinical medicine, Biliary atresia, medicine, Thrombus, health care economics and organizations, Collateral vein, business.industry, Blood flow, Meso-Rex bypass, medicine.disease, Surgery, Portal vein thrombosis, Portal steal phenomenon, 030220 oncology & carcinogenesis, cardiovascular system, Portal hypertension, 030211 gastroenterology & hepatology, Ligation, business |
| الوصف: | Highlights • Re-do of a meso-Rex Bypass is a feasible option with good outcomes. • A large collateral vein is an alternative for an autologous venous conduit in a MRB. • Large collaterals ligation during MRB should be performed to avoid portal steal. Introduction In children with extrahepatic portal vein obstruction or those who develop portal vein thrombosis after liver transplant, the use of Meso-Rex Bypass (MRB) creates a more physiological state by redirecting mesenteric blood flow back into the intrahepatic portal system via a venous conduit. Presentation of case A 3-year-old female with biliary atresia associated with polysplenia syndrome and a surgical history of Kasai portoenterostomy procedure, and an ABO incompatible whole liver transplant. Within a year after transplant she presented with prehepatic portal hypertension, that was treated with MRB using a deceased donor ABO compatible iliac vein as conduit. Six months later, she was taken to the operating room for bypass revision, during the procedure the MRB showed no flow and no thrombus, and a large splenorenal collateral vein that was causing a portal perfusion steal phenomenon was observed. After dissecting the collateral vein, an 8 cm x8 mm segment of this vessel was used as an autologous conduit to re-do the Rex. Discussion Failed of MRB can be attributed to portal steal phenomenon, hypercoagulable disorders, bypass contraction or kinking. In this case we believe the culprit to be the former. When there is a history of longstanding portal hypertension, large collaterals develop; thus, intraoperative portal vein flow measurement is critical and ligation of large collaterals during liver transplantation and MRB should be performed to avoid portal steal phenomenon postprocedure. Conclusion Using a collateral vein as an alternative autologous venous conduit is a feasible option that can have durable success. |
| تدمد: | 2210-2612 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::af9653c13f78505cd66b83a545ff5c0a https://doi.org/10.1016/j.ijscr.2019.05.051 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....af9653c13f78505cd66b83a545ff5c0a |
| قاعدة البيانات: | OpenAIRE |
Full Text via ClinicalKey | تدمد: | 22102612 |
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