PMC5821981_01
Preoperative CT scan showing PV thrombosis and portosystemic shunts. Blue arrow: PVT. Red arrow: portosystemic shunts. Yellow arrow: right colic vein.
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fig1
Preoperatively, a CT scan demonstrated a 3b PVT, with partial thrombosis of the SMV and a complete thrombosis of the right branch of the portal vein (Figure 1), along with diffuse portosystemic shunts (Figure 1). No splenorenal shunts were observed in the preoperative imaging neither intraoperatively (Figure 1).
Drawing showing the anatomy after jump graft interposition (the pancreas is split for graphic reasons).
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fig2
Then, it was passed anteriorly to the pancreas and behind the pylorus, and after evaluating the adequate length of the graft, an end-to-end anastomosis was sewn with a 6-0 monofilament running suture between the iliac vein graft and the donor PV (Figures 2 and 3).
Intraoperative picture showing iliac vein jump graft from the right colic vein to the donor PV. (a) End-to-end PV-jump graft anastomosis; (b) end-to-side jump graft-right colic vein anastomosis. The vessel closed with the Hem-o-lok and lifted with the forceps is the native PV.
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fig3
Then, it was passed anteriorly to the pancreas and behind the pylorus, and after evaluating the adequate length of the graft, an end-to-end anastomosis was sewn with a 6-0 monofilament running suture between the iliac vein graft and the donor PV (Figures 2 and 3).
Postoperative CT scan showing regular PV inflow and no anastomotic defects.
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fig4
No anastomotic defects were found at the postoperative CT scan 10 months after the surgery (Figure 4).