Repeated Shunt Surgery in a Patient with Portal Hypertension

F. J. Dudley, G. P. Young, I. E. Mclnnes

Research output: Contribution to journalArticlepeer-review

Abstract

Summary: A 45‐year‐old male with chronic active hepatitis and portal hypertension had a mesocaval interposition graft performed because of repeated uncontrolled bleeding from oesophageal varices. Acute hepatocellular failure, manifested by Grade IV encephalopathy and severe coagulopathy, developed early in the post‐operative course despite the absence of hepatic necrosis or other precipitating factors. Both encephalopathy and coagulopathy resolved rapidly following ligation of the shunt. Variceal bleeding recurred and nine months later an emergency distal lienorenal shunt was performed. Post‐operatively the shunt was shown to be patent and there has been no encephalopathy or recurrence of variceal bleeding. It is concluded that (1) the splanchnic haemodynamic effects of a mesocaval interposition graft can result in severe hepatocellular failure and this can be reverted by shunt ligation and (2) the distal lienorenal shunt, while effectively reducing the risk of haemorrhage from varices, may be less likely to result in post‐operative encephalopathy than more conventional forms of portal decompressive surgery.

Original languageEnglish
Pages (from-to)413-416
Number of pages4
JournalAustralian and New Zealand Journal of Medicine
Volume8
Issue number4
DOIs
Publication statusPublished - Aug 1978
Externally publishedYes

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