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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World J Gastroenterol ; It complicated by thrombosis, stenosis and encephalopathy through portal flow diversion from the liver.

Distal splenorenal shunt

Does the Warren shunt correct hypersplenism? However, the mean duration of surgery and the mean intraoperative blood loss were significantly less for patients in Group II than for those in Group I. Ten to twenty percent of patients were not controlled with endoscopic and pharmacological therapy, known as refractory variceal bleeding which needs more aggressive therapies to deal with it[ 78 ].

Living donor liver graft. Thus, there is a need for an effective schistosomal control program including of health and hygiene education, reduction of water contamination through sanitary splenorenql safe water supply facilities, snail control measures and mass chemotherapy to eliminate the threat from several endemic countries[ 12 ]. However, because most surgeons find Linton’s shunt procedure technically difficult, we felt that a simpler technique was needed. Portal hypertension is a condition characterized by increased pressure in the portal vein the vein that carries blood from the digestive organs to the liver.

Venous cutdown Arteriotomy Phlebotomy.

Propranolol reduces variceal pressure and wall tension in schistosomiasis presinusoidal slenorenal hypertension. Therefore, it has a great potential to control recurrent bleeding episodes and correction of portal hypertension[ – ].


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

Fusion fasciae derive their name from splenorehal developmental roots; they originate from the fusion of various membranes. Also, terlipressin improves the renal function of hepatorenal syndrome splenotenal by reducing renal vasoconstriction and should not be used in patients with cardiovascular disease[ 88 – 92 ].

Sonographic prediction of variceal bleeding in patients with liver fibrosis due to Schistosoma mansoni. It is not feasible to provide only nonsurgical management of portal hypertension by the administration of blood transfusions, after every episode of bleeding, in the hope that patients will get over their disease.

Surgical shunts, particularly proximal splenorenal shuht, are an excellent choice for the splenoeenal of chronic variceal shnt. Nat Rev Microbiol ;2: The improved surgical techniques in splenopancreatic disconnection and shung division significantly reduced postoperative encephalopathy risk and give good results in patients with schistosomal portal hypertension[- ].

Laminated thrombus is visible within lumen of stent. A comparison of treatment with transjugular intrahepatic portosystemic shunt or dplenorenal splenorenal shunt in the management of variceal bleeding prior cistal liver transplantation. The human body contains several fusion fasciae, such as the fusion fascia of Treitz at the head of the pancreas and the fusion fascia of Toldt along the body and tail of the pancreas 11 Figs. Buildup of fluid in the belly ascites Repeat bleeding from the varices Encephalopathy loss of brain function because the liver is unable to remove toxins from the blood.

Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. DSRS was performed in 11 children between the ages of 7 and 15 years: Before diagnostic endoscopy intravenous vasoactive therapy must start urgently with 2 mg every 4 h for the first 48 h and maintained for 5 days using 1 mg of terlipressin every 4 h to prevent rebleeding or somatostatin mg bolus dose followed by mg infused hourly as the second choice for 5 days.


Patients with schistosomiasis have prolongation of the bleeding profile including prothrombin time, partial thromboplastin time, thrombin time and hypofibrinogenemia which are well-established findings[ 29 ]. Angiogram to view inside the arteries Blood tests Endoscopy Galactose liver function test Give your health care provider a list of all the medicines you take prescription and over-the-counterherbs, and supplements.

Varices in portal hypertension: Comparison of distal and proximal splenorenal shunts: The blood flow to the liver is maintained through the portal vein. Your provider will explain the procedure and tell you when to stop eating and drinking before the surgery. However, as shown by several clinical trials, there is a tendency for gradual attrition of hepatic portal flow to occur as the high-pressure mesenteric venous system develops collateral branches to the shunt.

Sign in to save your search Sign in to your personal account. Other studies were showed that the distaal of recurrent variceal bleeding post-DSRS is 3.

Acknowledgment We are grateful to Dr. See all authors and affiliations. Of particular note is the finding that thrombosis of the portal vein developed within the first week of surgery in 5 patients, contributing to delay in resolution of postoperative ascites in all. The left renal vein clamped by Satinsky clamp and opened over sufficient length medially. J Am Coll Surg. Baillieres Clin Gastroenterol ;