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Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living-related liver transplantation. Case report
- Source :
- Pediatric Transplantation. 22:e13111
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation. Fil: Rubio, Juan S.. Fundación Favaloro; Argentina Fil: Rumbo, Carolina. Fundación Favaloro; Argentina Fil: Farinelli, Pablo A.. Fundación Favaloro; Argentina Fil: Aguirre, Nicolás. Fundación Favaloro; Argentina Fil: Ramisch, Diego A.. Fundación Favaloro; Argentina Fil: Paladini, Hugo. Fundación Favaloro; Argentina Fil: D´Angelo, Pablo. Fundación Favaloro; Argentina Fil: Barros Schelotto, Pablo. Fundación Favaloro; Argentina Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina
- Subjects :
- PORTAL THROMBOSIS
medicine.medical_specialty
CIENCIAS MÉDICAS Y DE LA SALUD
Cirrhosis
Medicina Clínica
030230 surgery
03 medical and health sciences
0302 clinical medicine
Biliary atresia
Ascites
medicine
PORTO-SYSTEMIC SHUNT
LIVING DONOR LIVER TRANSPLANTATION
Transplantation
business.industry
Ultrasound
medicine.disease
Collateral circulation
Hypoplasia
Surgery
medicine.anatomical_structure
Pediatrics, Perinatology and Child Health
030211 gastroenterology & hepatology
Gonadal vein
medicine.symptom
business
Transplantes
Shunt (electrical)
Subjects
Details
- ISSN :
- 13973142
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Pediatric Transplantation
- Accession number :
- edsair.doi.dedup.....d84c6fc401cdb992b48d7756793c320d