PMC3994599_01
(A, B) Preoperative axial and coronal reformatted computed tomography scan images showing an obliterated main (arrowhead) and left (open arrow) intrahepatic portal vein. Note the massively enlarged spleen (Sp).
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F1
The size and patency of the umbilical portion of the intrahepatic left portal vein were assessed by preoperative Doppler ultrasonography and computed tomography; there was massive splenomegaly and no detectable intrahepatic left portal vein (Fig. 1).
Operative findings showing the transposed coronary vein (white arrows) anastomosed end-to-side to the ventral portion of the extrahepatic left portal vein using nonabsorbable monofilament interrupted sutures.
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F2
This vein was fully mobilized, divided, and then transposed across the mesocolon and behind the pylorus to the intrahepatic left portal vein to which it was anastomosed end-to-side using nonabsorbable monofilament interrupted sutures (Fig. 2).
(A, B) Postoperative venogram of the splenic vein showing a brisk flow to the left intrahepatic portal vein (open arrows) via the meso-Rexshunt (arrowheads).
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F3
Unclamping of the meso-Rex shunt immediately allowed adequate portal flow into the liver, as confirmed by intraoperative portography, and there were no remaining large portosystemic shunts (Fig. 3).
(A-C) Axial and coronal reformatted computed tomography scan images at the 22-day follow-up showing increased portal flow (open arrows) via the preserved meso-Rex shunt (arrowheads).
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F4
Postoperative recovery was rapid and uneventful, with liver function tests within normal ranges and normal portal flow observed by Doppler ultrasonography and computed tomography (Fig. 4).