Extra hepatic portal vein obstruction with portal biliopathy

Jan 11 2023 | Medicover Hospitals

A 45 yr old female presented to a local hospital in Srikakulam with jaundice and abdominal pain. The initial evaluation had shown an obstructive jaundice pattern, and MRCP was reported as portal cavernoma, focal stricture at common hepatic duct, chronic calculous cholecystitis. The patient had undergone ERCP (Endoscopic retrograde cholangiopancreatography) along with CBD (Common bile duct) stenting and was referred to Srikakulam medicover hospital for CHD (common hepatic duct) management.

We have revaluated the patient with CT portovenogram which was highly suggestive of extrahepatic portal vein obstruction, multiple pericholecystitic & pericholedochal, perigastric, perisplenic collaterals, splenomegaly and cholelithiasis with CBD stent in situ, and LFT (Liver function tests) showed raised alkaline phosphatase. Hence we planned for a splenectomy with PSRS (Proximal splenorenal shunt) & cholecystectomy in the same sitting. Doppler USG showed a splenic vein which was around 7 mm in diameter and normal renal vein anatomy. The procedure was performed by a left modified makuuchi incision, and the liver is normal. Splenectomy was done and meticulous care was taken to avoid excess bleeding. 3-4 cm splenic vein dissected.

The patient was heparinised, and end to side anatomises of splenic vein and left renal vein was done using 6-0 prolene continuous sutures, followed by subtotal cholecystectomy. Postoperatively the patient had a low-output bile leak, which was resolved in a few days. Doppler USG confirmed shunt patency and the patient got discharged on 9th pod on oral anticoagulants.

Combining PSRS with SUBTOTAL CHOLECYSTECTOMY is uncommon.

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