Document Detail

Early variceal rebleeding after successful distal splenorenal shunt.
MedLine Citation:
PMID:  3486647     Owner:  NLM     Status:  MEDLINE    
Of 77 patients with repeated variceal hemorrhage who underwent distal splenorenal shunt, five (6.5%) developed rebleeding despite a patent splenorenal anastomosis. Three of the five patients died. Early variceal rebleeding usually indicates shunt thrombosis but may occur with a patent anastomosis. Anatomic or functional left renal vein and/or splenic vein hypertension producing incomplete variceal decompression is generally the cause. Ineffective separation of the main portal vein from the gastrosplenic venous plexus may coexist and further intensify variceal congestion. Urgent angiographic studies and direct shunt catheterization with measurement of splenic vein, left renal vein, and inferior vena cava pressures should be performed to plan appropriate therapy. A significant gradient between the splenic and renal veins is evidence of an unsatisfactory anastomosis and should be managed by balloon angioplasty or reoperation. High splenic and left renal vein pressures with a gradient of more than 10 mm Hg between the renal vein and the inferior vena cava indicate renal vein hypertension. Initial therapy should include serial injection sclerotherapy, as renal vein hypertension will usually resolve over time as additional collaterals develop. However, persistent or recurrent variceal hemorrhage may require total portal decompression to bypass the restrictive left renal vein segment.
F E Eckhauser; R A Pomerantz; J A Knol; W E Strodel; D M Williams; J G Turcotte
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  121     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  1986 May 
Date Detail:
Created Date:  1986-05-27     Completed Date:  1986-05-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  547-52     Citation Subset:  AIM; IM    
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MeSH Terms
Esophageal and Gastric Varices / physiopathology,  radiography,  surgery*
Gastrointestinal Hemorrhage / physiopathology,  radiography,  surgery*
Middle Aged
Portasystemic Shunt, Surgical*
Postoperative Period
Renal Veins / physiopathology,  radiography
Splenic Vein / physiopathology,  radiography
Splenorenal Shunt, Surgical*
Venous Pressure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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