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Portal Decompression in Portal Vein Thrombosis Following Central Splenorenal Shunt

Patients with bleeding esophageal varices present a unique management problem, as only 50 percent of such patients survive throughout the subsequent year.’ In 50 to 60 percent of patients, bleeding stops spontaneously, but in the remainder, bleeding is persistent, and surgical management becomes necessary. Initial non-operative therapy includes pitressin, balloon tamponade, and more recently sclerotherapy. In this report we describe two patients with bleeding varices who underwent splenectomy and central splenorenal shunts. One developed an isolated nonocclusive thrombus in the portal vein two weeks after shunt surgery. Complete occlusion of the splenorenal shunt developed and there was recurrence of bleeding. The thrombus was removed from the portal vein, and a standard end-to-side portacaval shunt was done to control variceal bleeding. In the second patient, a central splenorenal shunt had been performed seven years before recurrence of variceal bleeding. At the time of construction of a portacaval shunt for decompression, the portal vein was found to have a thrombus which was firm and adherent to the medial wall. The thrombus was removed and a portacaval shunt was performed with cessation of variceal bleeding.