Surgical Treatment of Giant Spontaneous Splenorenal Shunt Associated with Idiopathic Hypertension -A Report of Two Cases-

Kimihiro Nakajima, Hiroyuki Katoh, Shunichi Okushiba, Eiji Shimozawa, Tatsuzo Tanabe

Second Department of Surgery, Hokkaido University School of Medicine

Two patients with giant spontaneous splenorenal shunts are presented. Case 1. A 34-year-old man spontaneously developed a giant splenorenal shunt. Small esophageal varices were present, and mentation was normal. Because the serum anmonia concentration was elvated, we constructed a selective splenorenal shunt with splenopancreatic and gastric disconnection to decrease shunt flow and prevent enlargement of the varices. Case 2. A 27-year-old man was noted to have small esophageal varices without any elevation of the serum anmonia concentration. We constructed a splenorenal shunt using a spontaneous splenorenal shunt with spleno-gastric disconnection to prevent subsequent development of hepatic encephalopathy. Patients with a giant spontaneous splenorenal shunt are at risk of progressive hepatic encephalopathy and liver dysfunction secondary to reduced portal vein flow. To prevent this, it is necessary to divert the shunt flow; a selective splenorenal shunt with pancreatic gastric disonnection should be constructed to prevent enlargement of esophageal varices.

Key words
portal hypertension, spontaneous splenorenal shunt, distal splenorenal shunt

Reprint requests
Kimihiro Nakajima Second Department of Surgery, Hokkaido University School of Medicine
N-15, W-7, Kita-ku, Sapporo, 060 JAPAN

Accepted
June 17, 1992

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