Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Successful use of a mesocaval shunt to treat refractory ascites in a chronic pancreatitis induced portal vein thrombosis

  • Souradeep Dutta (Division of Hepatopancreatobiliary Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Bishal Pal (Division of Hepatopancreatobiliary Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Duvuru Ram (Department of Cardiovascular and Thoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Sreevathsa Kadaba Shyamprasad (Department of Cardiovascular and Thoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Vishnu Prasad Nelamangala Ramakrishnaiah (Division of Hepatopancreatobiliary Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research)
  • Received : 2021.10.19
  • Accepted : 2021.11.26
  • Published : 2022.05.31
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Abstract

The state of intense peripancreatic inflammation in chronic pancreatitis can give rise to various vascular complications such as venous thrombosis and arterial pseudoaneurysms. Due to its intimate location with the pancreas, spleno-mesenteric-portal axis suffers the greatest blunt of thrombotic complications. Treatment modalities for such cases of chronic portal vein thrombosis have always been controversial and challenging. Medical management with anticoagulants is both risky and unsatisfactory due to presence of varices, hypersplenism, and persistence of the inflammatory pathology. Although endovascular techniques have been tried in various case reports, there are definite anatomical challenges in cases of long segment porto-mesenteric thrombosis with massive ascites. Surgical shunts have been historically described for cirrhotic and non-cirrhotic portal hypertensive patients. However, its use in patients with refractory ascites due to chronic pancreatitis induced portal vein thrombosis has not been reported in the medical literature. Here, we present a case of an extensive portal vein thrombosis with massive refractory ascites in a patient with alcohol-induced chronic pancreatitis successfully treated with a surgical mesocaval shunt using an interposition small diameter graft.

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References

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