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Title: Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited
Authors: Mali, V.P. 
Robless, P.A. 
Aw, M. 
Loh, D.L. 
Quak, S.H. 
Prabhakaran, K. 
Keywords: liver transplantation
portal vein
portasystemic shunt
Issue Date: Jun-2012
Citation: Mali, V.P., Robless, P.A., Aw, M., Loh, D.L., Quak, S.H., Prabhakaran, K. (2012-06). Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited. Pediatric Transplantation 16 (4) : E120-E124. ScholarBank@NUS Repository.
Abstract: PV thrombosis is not an uncommon occurrence following pediatric LT. Symptomatic PHT following PV thrombosis is treated medically, surgical portosystemic shunting (mesorex, splenorenal, and mesocaval) being reserved for refractory cases. A 10-yr-old boy suffered recurrent malena and hemorrhagic shock because of chronic PV thrombosis following LT nine yr ago (1999). Extensive work-up failed to localize the bleeding source. The liver function remained normal. Initial attempts at surgical shunts failed owing to thrombosis (mesocaval 2001, splenorenal, inferior mesenteric-left renal vein, splenic-left external iliac vein 2008). In this situation, we performed a Clatworthy shunt by anastomosing the divided lower end of the LCIV to the side of SMV. There was a single, large caliber anastomosis. Post-operatively, the malena stopped completely, and clinically, there was no lower limb edema or encephalopathy. Doppler USG revealed persistence of hepatopetal flow within the portal collaterals. Follow-up at two yr reveals stable hepatic function with a patent shunt. To the best of our knowledge, we are not aware of a Clatworthy shunt being performed in a transplant setting. We reviewed the literature pertaining to this shunt in non-transplant patients with PHT. © 2011 John Wiley & Sons A/S.
Source Title: Pediatric Transplantation
ISSN: 13973142
DOI: 10.1111/j.1399-3046.2011.01548.x
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