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Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction

Pediatric Surgery International volume 27, pages 315–319 (2011)Cite this article

Abstract

Purpose

Mesenterico-left portal vein (meso-Rex) bypass is as an effective modality for restoring intrahepatic portal perfusion in patients with extrahepatic portal vein obstruction. Achieving sufficient patency is difficult with end-to-side anastomosis of a bypass graft to a small or hypoplastic left portal vein in the Rex recessus. Here, we describe the use of a recanalized umbilical vein in the round ligament as a conduit for bypass construction in two patients.

Methods

Case 1 was an 11-year-old boy diagnosed with rupture of the esophageal varices and hypersplenism due to congenital extrahepatic portal hypertension. Because of persistent hypersplenism and thrombocytopenia, he underwent meso-Rex bypassing with a left iliac vein graft interposed between the umbilical vein and the superior mesenteric vein. Case 2 was a neonate with a large hepatic tumor (mesenchymal hamartoma) that developed abdominal compartment syndrome at birth. The tumor was removed by right hepatectomy with excision of the portal vein bifurcation at 3 days of age. Porto-Rex bypassing was accomplished by end-to-end anastomosis between the portal vein trunk and the umbilical vein.

Results

Sufficient hepatopetal portal flow through the umbilical vein was achieved in both patients and maintained for over 16 and 13 months, respectively. Although hypersplenism remained in Case 1, intrahepatic portal vein branches gradually widened and the cavernoma in the hepatic hilum disappeared within 2 months. Neither patient had symptoms or signs of portal hypertension at the most recent follow-up.

Conclusion

Using the umbilical vein as a vein conduit may facilitate construction of a meso/porto-Rex bypass and restore intrahepatic portal vein perfusion in patients with extrahepatic portal vein obstruction.

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Acknowledgment

The authors declare no conflicts of interest. No financial or pharmaceutical support was given to any of the authors.

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Affiliations

  1. Department of Surgery, Kanagawa Children’s Medical Center, 138-4, Mutsukawa 2-chome, Minami-ku, Yokohama, 232-8555, Japan

    Masato Shinkai, Youkatsu Ohhama, Shohei Honda, Norihiko Kitagawa, Kyoko Mochizuki, Hiroshi Take, Yoshihiro Hirata & Yoshiko Usui

  2. Department of Neonatology, Kanagawa Children’s Medical Center, 138-4, Mutsukawa 2-chome, Minami-ku, Yokohama, 232-8555, Japan

    Jun Shibasaki

  3. Department of Cardiology, Kanagawa Children’s Medical Center, 138-4, Mutsukawa 2-chome, Minami-ku, Yokohama, 232-8555, Japan

    Hideaki Ueda

  4. Department of Radiology, Kanagawa Children’s Medical Center, 138-4, Mutsukawa 2-chome, Minami-ku, Yokohama, 232-8555, Japan

    Noriko Aida

Authors
  1. Masato Shinkai
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  2. Youkatsu Ohhama
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  3. Shohei Honda
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  4. Norihiko Kitagawa
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  5. Kyoko Mochizuki
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  6. Hiroshi Take
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  7. Yoshihiro Hirata
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  8. Yoshiko Usui
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  9. Jun Shibasaki
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  10. Hideaki Ueda
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  11. Noriko Aida
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Correspondence to Masato Shinkai.

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Shinkai, M., Ohhama, Y., Honda, S. et al. Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction. Pediatr Surg Int 27, 315–319 (2011). https://doi.org/10.1007/s00383-010-2742-y

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Keywords

  • Umbilical vein
  • Meso-Rex shunt
  • Extrahepatic portal vein obstruction
  • Portal vein reconstruction