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Pediatric Surgery International

, Volume 31, Issue 1, pp 101–105 | Cite as

Meso-Rex bypass to manage prehepatic portal hypertension after the failure of an intrahepatic portosystemic stent shunting

  • Fabrizio di Francesco
  • Lidia Monti
  • Chiara Grimaldi
  • Cristina Lo Zupone
  • Arianna Bertocchini
  • Jean de Ville de GoyetEmail author
Case Report

Abstract

A cavernomatous transformation of the extrahepatic portion of the portal vein is a common cause of chronic portal hypertension in children. A few attempts at radiological interventions have been reported, but have rarely been successful. In this report, a surgical Meso-Rex bypass was performed to treat complicated prehepatic portal hypertension, after the insertion of an intrahepatic stent for portosystemic shunting had failed. The review of this case nicely illustrates how differently effective are these two shunting procedures—in terms of restoring hepatopetal flow, managing portal hypertension, and establishing—or not—portosystemic connections.

Keywords

Extrahepatic portal hypertension Transjugular intrahepatic portosystemic shunt Complications Surgical technique Meso-Rex bypass 

Abbreviations

USD

Ultrasound Doppler

PV

Portal vein

CT

Computed tomography

MR

Magnetic resonance

TIPSS

Transjugular intrahepatic portosystemic stent shunting

WBC

White cells count

INR

International normalised ratio

PTT

Partial thromboplastin time

PT

Prothrombin time

MRB

Meso-Rex bypass

PHPH

Prehepatic portal hypertension

PSS

Portosystemic shunts

Notes

Conflict of interests

All of the authors contributed to this analysis, and to the manuscript, at various degrees of assistance. All approved the final manuscript, and all agreed to be associated as authors. The authors declare no conflict of interest.

Ethical standards

This study was conducted retrospectively, with the consent of the patient’s family, and after the patient had been cared for, according to the standard rules of care, and in his best interest. Full information was given and a family consent was obtained, wherever it was necessary for the care. Because it was a retrospective collection of existing data, and because they were anonymised, no ethical committee approval was requested (as per the 1964 Declaration of Helsinki and its later amendments).

Supplementary material

Supplementary material 1 (MPG 30308 kb)

Supplementary material 2 (MPG 29756 kb)

Supplementary material 3 (MPG 29546 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Fabrizio di Francesco
    • 1
  • Lidia Monti
    • 2
  • Chiara Grimaldi
    • 1
  • Cristina Lo Zupone
    • 2
  • Arianna Bertocchini
    • 1
  • Jean de Ville de Goyet
    • 1
    Email author
  1. 1.Department of Paediatric Surgery and Transplantation CentreBambino Gesù Children’s Hospital, IRCCSRomeItaly
  2. 2.Liver and Digestive Radiology Unit, Department of ImagingBambino Gesù Children’s HospitalRomeItaly

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