case_images: PMC3994599_01
case_images: (A, B) Preoperative axial and coronal reformatted computed tomography scan images showing an obliterated main (arrowhead) and left (open arrow) intrahepatic portal vein. Note the massively enlarged spleen (Sp).
case_images: astr-86-105-g001.jpg
case_images: PMC3994599_01_astr-86-105-g001.jpg
case_images: F1
case_images: The size and patency of the umbilical portion of the intrahepatic left portal vein were assessed by preoperative Doppler ultrasonography and computed tomography; there was massive splenomegaly and no detectable intrahepatic left portal vein (Fig. 1).
case_images: Operative findings showing the transposed coronary vein (white arrows) anastomosed end-to-side to the ventral portion of the extrahepatic left portal vein using nonabsorbable monofilament interrupted sutures.
case_images: astr-86-105-g002.jpg
case_images: PMC3994599_01_astr-86-105-g002.jpg
case_images: F2
case_images: This vein was fully mobilized, divided, and then transposed across the mesocolon and behind the pylorus to the intrahepatic left portal vein to which it was anastomosed end-to-side using nonabsorbable monofilament interrupted sutures (Fig. 2).
case_images: (A, B) Postoperative venogram of the splenic vein showing a brisk flow to the left intrahepatic portal vein (open arrows) via the meso-Rexshunt (arrowheads).
case_images: astr-86-105-g003.jpg
case_images: PMC3994599_01_astr-86-105-g003.jpg
case_images: F3
case_images: Unclamping of the meso-Rex shunt immediately allowed adequate portal flow into the liver, as confirmed by intraoperative portography, and there were no remaining large portosystemic shunts (Fig. 3).
case_images: (A-C) Axial and coronal reformatted computed tomography scan images at the 22-day follow-up showing increased portal flow (open arrows) via the preserved meso-Rex shunt (arrowheads).
case_images: astr-86-105-g004.jpg
case_images: PMC3994599_01_astr-86-105-g004.jpg
case_images: F4
case_images: Postoperative recovery was rapid and uneventful, with liver function tests within normal ranges and normal portal flow observed by Doppler ultrasonography and computed tomography (Fig. 4).