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case_images: Multiplanar contrast-enhanced computed tomography (CT) 3D reconstructions. A: pretransplant CT showing grade 3 portal vein thrombosis, with proximal involvement of the superior mesenteric vein (thin arrow). A thin portal vein collateral is identified at the hepatoduodenal ligament (thick arrow), as well as a large portosystemic shunt (asterisk) arising from distal superior mesenteric vein and draining into the inferior vena cava, below the outlet of right renal vein. B: post-transplant CT showing patency and position of the mesoportal jump graft.
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case_images: Pre-LT computed tomography (CT) highlighted the presence of a large thrombus in the portal vein and proximal SMV, sparing the splenic vein and the distal SMV (Fig. 1A). Repeated Doppler ultrasound examinations and a CT scan performed in the postoperative period demonstrated patency of the reconstructed venous axis and otherwise regular graft perfusion (Fig. 1B).
case_images: Drawing of the U-shaped mesoportal jump graft.
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case_images: SMV was tangentially clamped and an end-to-side anastomosis between the venous patch and the SMV was performed using a 5/0 polypropylene suture, followed by an end-to-end anastomosis between the venous patch and graft portal vein using the same material (Fig. 2).
case_images: Intraoperative pictures at lower (A) and higher (B) magnification, showing the position of mesoportal jump graft in relation to the pancreatic head and first duodenum.
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case_images: After clamps removal, the jump graft appeared as optimally bypassing the duodenum and the pancreatic head, in the absence of any tension on the reconstructed vascular axis (Fig. 3).
case_images: Postoperative trend of transaminases, bilirubin, INR and platelets.
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case_images: At 6-month follow-up he is in good health, with normal hepatic function and regular graft perfusion (Fig. 4).