Dados do Trabalho

Título

LIVER TRANSPLANTATION IN THE SETTING OF A SPONTANEOUS SHUNT BETWEEN THE SUPERIOR MESENTERIC VEIN AND THE RIGHT RENAL VEIN: CASE REPORT

Introdução

Portal vein thrombosis may trigger the occurrence of spontaneous portosystemic shunts. However shunts between the superior mesenteric vein and the right renal vein are very rare.

Material e Método

Here, we report the rare case of a patient who underwent liver transplantation in the setting of shunt between the superior mesenteric vein (SMV) and the right renal vein (RRV).

Resultados

A 67-year-old white man presenting with Child C cirrhosis secondary to hemochromatosis, persistent encephalopathy was listed for liver transplant (LT). He was prioritized for LT due to persistent Grade encephalopathy 4, and his appealed Model for End Stage Liver Disease (MELD score) was 29. Doppler-ultrasound showed absence of blood flow in the intrahepatic portal system, portoportal venous collateral network, low-velocity hepatopetal flow and cavernomatous transformation of the portal vein (PV). Abdominal angiotomography confirmed the presence of cavernomatous transformation of the PV, and identified a large spontaneous shunt between the SMV and the RRV (Figure 1). The diameter of the SMV at the confluence level for formation of the PV was 1.4 cm. underwent LT by receiving a liver from a 17-year-old brain-dead deceased donor, victim of trauma. The liver was preserved in IGL-1 storage solution. A large shunt between the SMV and the RRV was detected intraopreatively (Figure 2). Although thas no PV thrombosis, the PV was atrophic and had a reduced flow. PV pressure was 22 mmHg, and after shunt ligation the pressure in the portal vein increased to 32 mmHg. Post-transplant, a bile leak, but no PV complications occurred, and the patient was discharged home in good health.

Discussão e Conclusões

All spontaneous shunts should be ligated during LT. PV pressure and/or flow should be measured before and after the ligation of the shunt.

Palavras Chave

Spontaneous shunt