Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding. Wael Mohialddin Ahmed Doush1. the distal splenorenal shunt (dsrs) is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and. the distal splenorenal shunt (dsrs) procedure provides good long-term control of bleeding in many people with portal hypertension. dsrs controls bleeding in.

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Group I consisted of 6 male and 4 female patients with a mean age of By Angio-MRI the risk of variceal bleeding in patients can be evaluated through azygos blood flow measurement.

Ligation of small venous tributaries that arise from the pancreas and entering into the splenic vein.

Distal splenorenal shunt: MedlinePlus Medical Encyclopedia

Clin Liver Dis ;5: Sign in to save your search Sign in to your personal account. It is used to treat portal hypertension and its main complication esophageal varices.

Views Read Edit View history. Fusion fasciae derive their name from their developmental roots; they originate from the fusion of various membranes. Upper digestive bleeding in cirrhosis. Furthermore, liver transplantation considered in Child-Pugh class C patients[ 616299 ]. When blood can’t flow normally through the portal vein, it takes another path.

The effect of different shuntt of a bolus injection of somatostatin combined with a slow infusion on transmural oesophageal variceal pressure in patients with cirrhosis.

Ask which ones you need to stop taking before the surgery, and which ones you should take the morning of the surgery. When is liver transplant dietal in cirrhosis with bleeding varices?

Group II also consisted of 6 male and 4 female patients. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Continuous data were compared using Splrnorenal t test.

A tube in your vein IV that will carry fluid and medicine into your bloodstream A catheter in your bladder to drain urine An NG tube nasogastric that goes through your nose into your stomach to remove gas and fluids A pump with a button you can press when you need pain medicine As you are able to eat and drink, you will be given liquids and food.


Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Transjugular intrahepatic portosystemic shunt versus H-graft portacaval shunt in the management of bleeding varices: Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: Newly diagnosed patients must undergo screening OGD which considered as a gold standard test for detection of changes that indicate dista high risk of bleeding include cherry-red spots, varices on varices, large varices and erosion on varices [Figure 6] [ 59 ].

During the surgery, the vein from the spleen called the splenic vein is detached from the portal vein and reattached to the left kidney renal vein. Subsequently, hepatosplenomegaly and portal hypertension complicated by esophageal variceal bleeding, ascites and hepatic coma indicate the end stage of liver disease[ 202223 ]. Successful living-related partial liver transplantation to an adult patient. Angiographic study in patient presenting with third variceal bleed following transjugular intrahepatic portosystemic shunting.

The leading cause of death is recurrent variceal bleeding associated with a preserved liver function. Furthermore, color doppler ultrasound showed hepatic left lobe hypertrophy and right lobe atrophy which was commonly seen in the hepatosplenic schistosomiasis[ 33 ].

A Simplified Technique of Performing Splenorenal Shunt (Omar’s Technique)

Curr Treat Options Gastroenterol ; Support Center Support Center. This study was approved by the hospital’s ethics committee, and all patients gave informed consent to participate in the study. Furthermore, it eliminates the infective and hemopoietic effects of splenectomy. Within 12 h of hospital admission OGD performed to identify the source of bleeding and allowing hemostatic treatment done on an empty stomach through nasogastric tube lavage or i.

Oesophagogastric varices endoscopic views. Blood samples for baseline laboratory tests can be done upon initial presentation complete blood count; renal function test; liver function test; international normalized ratio.

Why the Procedure is Performed. Sabiston Textbook of Surgery. Also, it helped in regression of periportal fibrosis. Although the end-stage liver failure was rarely seen in schistosomal patients, the deterioration of hepatic reserve has been expected following massive variceal bleeding with developed ascites and the splenic size regression[].


Surgical shunts, particularly proximal splenorenal shunts, are an excellent choice for the control of chronic variceal bleeding. The mobility achieved by dissecting the fusion fascia of Toldt makes the pancreas pliable enough to be lowered to the level of the left renal vein.

Association of the therapeutic activity of praziquantel with the reversal of Symmers’ fibrosis induced by Schistosoma mansoni. The portal vein brings blood from the intestine, spleen, pancreas, and gallbladder to the liver. Salvage therapies for refractory variceal hemorrhage. Propranolol reduces variceal pressure and wall tension in schistosomiasis presinusoidal portal hypertension.

Then described terminal spine mature ova and lateral spine immature ova, produced by the female worms[ 1112 ].

Distal Splenorenal Shunt

The surgical treatment has been considered the best alternative for patients with schistosomal recurrent variceal bleeding due to well-preserved liver function and upper digestive tract bleeding is the dangerous disease complication[ – ]. The segment of the splenic vein lying on the posterior aspect of the pancreas is then dissected. It desirable to divide left adrenal vein which achieves mobilization of the left renal vein and bring it up into a side-biting vascular clamp for anastomosis without tension with leaving the left gonadal vessel intact which serve as an outflow tract [Figure 11] [, ].

Sign in to make a comment Sign in to your personal account. Therefore, we recommend the routine use of this simplified technique Omar’s technique for the surgical treatment of portal hypertension. Purchase access Subscribe spleborenal. When you wake up after the surgery you will have: Tarek Shalaby Copy Editor: Immunopathogenesis of human schistosomiasis.

In addition, a combination of venous and arterial angiographic study gives information on superior mesenteric, portal and splenic veins patency, flow direction, hepatic diztal pressure gradient and left renal vein anatomy.