Abstract
Sixty patients who underwent distal splenorenal shunt were followed up from one to ten years, with an average of 5.6 years. Postoperative portography through the superior mesenteric artery was carried out in 58 of these patients and the remaining two were studied at autopsy. The diameter of the portal vein was unchanged in 65 per cent of the patients within 30 postoperative days, but it decreased remarkably in size one year after the surgery in one third of the patients, and it was observed in about half of the patients at 5 years after the surgery. Numerous collaterals had developed around the pancreas and stomach in the majority of cases presenting narrowing of the portal vein. Enormously dilated pancreatic veins directed to non-isolated distal splenic vein were identified in the autopsied cases. These findings strongly suggest that pancreatic veins connecting to the distal vein may play a leading role in production of malcirculation of the portal system after distal splenorenal shunt.
Similar content being viewed by others
References
Warren, W.D., Zeppa, R. and Fomon, J.J.: Selective transsplenic decompression of esophageal varices by distal splenorenal shunt. Ann. Surg. 166: 437–455, 1967.
Rotstein, L.E., Makowka, L., Langer, B., Blendis, L.M., Stone, R.M. and Colapinto, R.F.: Thrombosis of the portal vein following distal splenorenal shunt. Surg. Gynec. Ü Obstet. 149: 847–851, 1979.
Henderson, J.M., Millikan, W.J., Chipponi, J., Wright, L., Sones, P.J., Meier, L. and Warren, W.D.: The incidence and natural history of thrombus in the portal vein following distal splenorenal shunt. Ann. Surg. 196: 1–7, 1982.
Maillard, J.N., Flamant, Y.M., Hay, J.M. and Chandler, J.G.: Selectivity of the distal splenorenal shunt. Surgery 86: 663–671, 1979.
Marni, A., Trojsi, C. and Bell, L.: Distal splenorenal shunt: Hemodynamic advantage over total shunt and influence on clinical status, hepatic function and hypersplenism. Amer. J. Surg. 142: 372–376, 1981.
Warren, W.D., Millikan, W.J., Henderson, J.M., Wright, L., Kutner, M., Smith, R.B., Fulenwider, J.T., Salam, A.A. and Galambos, J.T.: Ten years portal hypertensive surgery at Emory: Results and new perspectives. Ann. Surg. 195: 530–542, 1982.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Isomatsu, T. Loss of selectivity of warren shunt in long-term observation. The Japanese Journal of Surgery 13, 202–206 (1983). https://doi.org/10.1007/BF02469477
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02469477