PMC7240169_01
Multiplanar contrast-enhanced computed tomography (CT) 3D reconstructions. A: pretransplant CT showing grade 3 portal vein thrombosis, with proximal involvement of the superior mesenteric vein (thin arrow). A thin portal vein collateral is identified at the hepatoduodenal ligament (thick arrow), as well as a large portosystemic shunt (asterisk) arising from distal superior mesenteric vein and draining into the inferior vena cava, below the outlet of right renal vein. B: post-transplant CT showing patency and position of the mesoportal jump graft.
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Pre-LT computed tomography (CT) highlighted the presence of a large thrombus in the portal vein and proximal SMV, sparing the splenic vein and the distal SMV (Fig. 1A). Repeated Doppler ultrasound examinations and a CT scan performed in the postoperative period demonstrated patency of the reconstructed venous axis and otherwise regular graft perfusion (Fig. 1B).
Drawing of the U-shaped mesoportal jump graft.
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SMV was tangentially clamped and an end-to-side anastomosis between the venous patch and the SMV was performed using a 5/0 polypropylene suture, followed by an end-to-end anastomosis between the venous patch and graft portal vein using the same material (Fig. 2).
Intraoperative pictures at lower (A) and higher (B) magnification, showing the position of mesoportal jump graft in relation to the pancreatic head and first duodenum.
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After clamps removal, the jump graft appeared as optimally bypassing the duodenum and the pancreatic head, in the absence of any tension on the reconstructed vascular axis (Fig. 3).
Postoperative trend of transaminases, bilirubin, INR and platelets.
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At 6-month follow-up he is in good health, with normal hepatic function and regular graft perfusion (Fig. 4).