Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt

A 26-year-old male suffered from recurrent variceal bleeding was considered for surgical therapy. Although we planned to perform a distal splenorenal shunt procedure, it was observed to be difficult. Therefore left adrenal vein was used as a conduit between left renal vein and splenic vein after splenic artery was ligated. He did well and was discharged from the hospital on the postoperative day 6. In the follow up period for nine months, endoscopic and ultrasonographic examinations were normal.We concluded that, in case of failure to perform distal splenorenal shunt due to technical problems, alternative porto-systemic shunt procedure using the adrenal vein as a vascular conduit can be safely employed.In spite of new therapeutic modalities such as pharmacologic, endoscopic (sclerotherapy or band ligation), and transjugular intrahepatic portosystemic shunt (TIPSS), surgical decompressive shunts still have an important place in the treatment of portal hypertension (PHT). One of the serious complications of PHT is variceal bleeding which can lead to death. Nevertheless, the success rate of the endoscopic and combined medical treatments is about 50%. A few surgical procedures such as Sugiura procedure for esophageal varices and Hassab-Paquet (A complete gastroesophageal devascularization with splenectomy) procedure for gastric varices have also been performed for PHT [1,2]. In case of failure of those procedures, surgical methods should be considered. Distal spleno-renal shunt (DSRS) and/or portocaval shunt are still regarded as the most popular surgical procedures in these patients [3]. Type of the surgical shunt should be chosen in the light of prognosis, anatomic variations and surgical experience.The technique of DSRS was first described by Warren in 1967. DSRS is originally end to side anastomosis between splenic and left renal veins [4]. End to side anastomosis may be unfavorable due to scar tissues or inappropriate diameter between the two veins. A few cases had