Faced with bleeding esophageal varices from portal hypertension and anatomic conditions that preclude the construction of a standard portosystemic shunt, any enlarged portal collateral draining the esophageal varices can be utilized to achieve decompression. A case is presented in which this was achieved by means of a Dacron H graft that was inserted between the gastroepiploic trunk and the inferior vena cava.
Report of a Case.—A 57-year-old man with cirrhosis was admitted after three episodes of variceal bleeding. Selective celiac, splenic, and superior mesenteric arteriography was performed. The extrahepatic portal vein, the splenic vein, and the superior mesenteric vein were not seen. All venous return was via collaterals and only the intrahepatic portal vein was identified. Despite the selective injection of a large bolus of contrast medium into the splenic artery, no visualization of the splenic vein could be obtained. Instead, the venous return from the spleen occurred in
ADAR R, RUBINSTEIN Z. Portal Decompression by Means of a Gastroepiploic to Inferior Vena Cava H Graft. Arch Surg. 1979;114(11):1345-1346. doi:10.1001/archsurg.1979.01370350147020