Alimentary tract and pancreas

Alimentarni trakt i pankreas

1Dragan Sagi},

2Vojislav N. Peri{i},

3Bo`ina Radevi},

2Mira Petrovi}

1Department of Radiology, Institute for

Cardiovascular Diseases Dedinje,

3Department of Surgery, Institute for

Cardiovascular Diseases Dedinje,

2University Children,s Hospital, Belgrade.

ARCH GASTROENTEROHEPATOL 2003; 22 (No 1 - 2): 12 – 17

Images in gastroenterology and hepatology

Wall-stent relieve of

obstructed distal splenorenal

shunt

Osloba|anje opstrukcije distalnog

spleno-renalnog {anta "wall-stentom"

( accepted May 15th, 2003 )

.

Twelve-year old boy was admitted to the University

Childrenís Hospital, Belgrade for further assessment of

hemathemesis, splenomegaly and hematological indices

of hypersplenism.

At the age of 5-year he was diagnosed as having portal

hypertension due to portal vein cavernoma. At that time he

bled from the oesophageal varices. Spleen was grossly

enlarged, laboatory investigations demonstrated normal

liver function tests, leukopenia and trombocytopenia.

He successfully undervent selective distal spleno-renal

shunt and partial splenic resection by one of us (BR). After

operation quick and complete variceal dissapearance, normalisation

of hematological indices, and increased growth

vlocity were recorded.

At admission spleen was palpable 2 cm below the left

costal margin. WBC count was 2.7, trombocytes were 67.

Upper GI endoscopy demonstrated oesophageal varives of

grade III.

After femoral vein puncture catheter was introduced

via renal vein into the splenic vein. Angiography demonstrated

almost completely obstructed spleno-renal shunt.

Figure 1.

Baloon dilatation (balloon caliber: 8mm) of stenotic

anastomisis was unsuccessful. Then Wall stent of 9 mm in

diameter was placed throught the narrowed shunt and further

balloon dilated up to the caliber of 10 mm. Figure 2.

This led to full obstruction relieve and reestablishment of

shunt patency. Next day oesophagogastroduoenoscopy

demonstrated complete varical dissapearance; laboratory

analyses showed normalisation of WBC and platelet

count.

Comment: We alredy demonstrated that the majority of

children and adults with portal hypertension who underwent

decompressive shunt surgery has been experiencing

prolonged variceal decompression and full relieve of

hematological abnormalities due to hypersplenism (1,2).

We also demonstrated that compromised spleno-renal

shunt was possible to dilate by percutaneous balloon

angioplasty with permanent full variceal decompression

and hematological remission (3).

This case further expand the therapeutical options in

controlling failed porto-systemic shunts, eg. spleno-renal

anastomosis. According to our knowledge we are the first

to demonstrate that in children with obstructed porto-systemic

shunts and fully blown picture of portal hypertension

Wall stent dilation of compromised spleno-renal

shunt may led to full relieve of clinical and laboratory

complications due to potla hypertension. This further

imply the necessity for regular "shunt surveillance" by

Doppler ultrasound in dagnosing early signs of shunt

shunt incopetence.

REFERENCES:

1.        Perišic VN, Radevic B, Sagic D, Perišic D.

Management of eextrahepatic portal hypertension

in children. Arch Gastroenterohepatol 2000;

19:90-3.

2.       Ješic R, Radevic B, Sagic D, Tomic D, Krstic M,

Aleksic T, Cvejic T, Bulat V, Šarenac R, Culafic Dj,

Bulajic M. The significance of shunt surgery in

treatment of portal hypertension. Arch

Gastroenterohepatol 2001; 20: 10-3.

3.       Perisic VN, Grujicic S, Sagic D, Radevic B, Bojic

M. Balloon dilatation of occluded spleno-renal

shunt. J Pediatr Gastroenterol Nutrition 1997; 25:

104-6.