A Retropancreatic Portal-Systemic Shunt for Portal Hypertension in Children

Abstract

CHILDREN with bleeding esophaegeal varices secondary to an extrahepatic block of the portal vein present a particularly difficult problem to the surgeon. A splenorenal shunt generally will not provide adequate portal decompression because of the small diameter of the splenic vein. A conventional portacaval shunt cannot be constructed because of portal vein thrombosis with cavernous transformation and multiple small periportal collateral vessels. Our experience with a retropancreatic anastomosis of the portal vein to the left renal vein or to the vena cava in six children has been encouraging. This experience is presented since it appears that in certain instances this may provide the most satisfactory method of portal decompression. It can be employed successfully following previous splenectomy or following previous unsuccessful shunt surgery of other types. Report of Cases Case 1 (97599). —This 7-year-old white boy was admitted to the Cincinnati Children's Hospital on March 20, 1962 because of massive