Mesocaval Interposition Shunt for Portal Vein Thrombosis and its Follow-Up by Sonography

Abstract

Portal hypertension is caused by multiple reasons but one variety has recently been highlighted after the improvement in diagnosis by ultrasonography and Doppler Imaging that is portal vein thrombosis. We in Jinnah Hospital, Lahore have operated upon fourteen such patients with excellent results so far. With regular follow up of 2-3 years we have not found any rebleed. We have used standard mesocaval interposition shunting with PTFE Graft in all patients and have followed them UJ) with regular 3-6 monthly ultrasound / Doppler studies. All the patient have shown immediate portal venous pressure fall from 37 mm Hg (Av.) to 16 mm Hg (Av.) intra operatively. All the patients showed decrease in the size of spleen from 17 cm (Av.) to 11.7 cm (Av.). Only one patient developed oesophageal varices grade-III but he did not bleed as well. We recommend this procedure for all portal hypertension patients who bleed from oesophageal varices despite at least two attempts to control by sclerotherapy / banding or who bleed from gastric varices. This modality of treatment is recommended both for elective and emergency cases.