Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction
| Autor: | Noriko Aida, Kyoko Mochizuki, Jun Shibasaki, Norihiko Kitagawa, Masato Shinkai, Hiroshi Take, Shohei Honda, Yoshiko Usui, Youkatsu Ohhama, Yoshihiro Hirata, Hideaki Ueda |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Umbilical Veins medicine.medical_specialty Hamartoma Portal venous pressure Anastomosis Esophageal and Gastric Varices Compartment Syndromes Hypersplenism Umbilical vein Right gastric vein Mesenteric Veins Hypertension Portal Humans Medicine In patient Child Left portal vein Portal Vein business.industry General surgery Liver Neoplasms Infant Newborn General Medicine Portal vein obstruction Surgery Pediatrics Perinatology and Child Health cardiovascular system business Perfusion |
| Zdroj: | Pediatric Surgery International. 27:315-319 |
| ISSN: | 1437-9813 0179-0358 |
| DOI: | 10.1007/s00383-010-2742-y |
| Popis: | Mesenterico-left portal vein (meso-Rex) bypass is as an effective modality for restoring intrahepatic portal perfusion in patients with extrahepatic portal vein obstruction. Achieving sufficient patency is difficult with end-to-side anastomosis of a bypass graft to a small or hypoplastic left portal vein in the Rex recessus. Here, we describe the use of a recanalized umbilical vein in the round ligament as a conduit for bypass construction in two patients.Case 1 was an 11-year-old boy diagnosed with rupture of the esophageal varices and hypersplenism due to congenital extrahepatic portal hypertension. Because of persistent hypersplenism and thrombocytopenia, he underwent meso-Rex bypassing with a left iliac vein graft interposed between the umbilical vein and the superior mesenteric vein. Case 2 was a neonate with a large hepatic tumor (mesenchymal hamartoma) that developed abdominal compartment syndrome at birth. The tumor was removed by right hepatectomy with excision of the portal vein bifurcation at 3 days of age. Porto-Rex bypassing was accomplished by end-to-end anastomosis between the portal vein trunk and the umbilical vein.Sufficient hepatopetal portal flow through the umbilical vein was achieved in both patients and maintained for over 16 and 13 months, respectively. Although hypersplenism remained in Case 1, intrahepatic portal vein branches gradually widened and the cavernoma in the hepatic hilum disappeared within 2 months. Neither patient had symptoms or signs of portal hypertension at the most recent follow-up.Using the umbilical vein as a vein conduit may facilitate construction of a meso/porto-Rex bypass and restore intrahepatic portal vein perfusion in patients with extrahepatic portal vein obstruction. |
| Databáze: | OpenAIRE |
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