PMC6600796_01
A) CT scan before the revision of the MRB showing a large splenorenal collateral vein (arrow), and the Rex recess (*). B) 3D reconstruction before the revision of the MRB showing a large splenorenal collateral vein (arrow). C) Intraoperative portogram performed during the revision of the MRB (arrow), showing a normal intrahepatic portal system. D) Image showing the re-do MRB (arrow) that was performed using a splenorenal collateral vein as an autologous venous conduit, Rex recess (*).
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We hypothesized that a large splenorenal collateral vein was potentially causing a portal venous perfusion steal phenomenon (Fig. 1A and B). This was anastomosed to the left portal vein at the Rex recess and a portogram demonstrated adequate intrahepatic portal system (Fig. 1C), followed by anastomosis to the spleno-mesenteric junction (Fig. 1D).
A) CT scan 1 month after the re-do MRB showing a patent conduit (arrow). B) 3D reconstruction of the re-do MRB 1 month after the operation.
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On follow-up, CT scan demonstrated sustained patency at 1- (Fig. 2) and 6-month follow up.