Extrahepatic portal hypertension due to chronic portal vein thrombosis with cavernous transformation treated with distal splenorenal shunt and postoperative massive lymphocele: a case report

Abstract

Extrahepatic portal hypertension in childhood is an important condition, frequently caused by chronic portal vein thrombosis with cavernous transformation. When physiological reconstruction is not viable, the selective portosystemic shunts remain as a useful option to preserve liver function. It is presented the case of a 13-year-old male adolescent with extrahepatic portal hypertension secondary to portal cavernoma. He had antecedents of upper gastrointestinal bleeding and severe hypersplenism. Because the portal anatomy was not suitable for a meso-Rex bypass, it was decided to perform a distal splenorenal shunt. In the postoperative period, the patient presented a massive abdominal lymphocele of high volume. The management was conservative, placing a closed Blake drainage and initiating total parenteral nutrition with fasting. After these measures, the lymphatic output had a progressive reduction until its total resolution, without needing more invasive surgeries. The distal splenorenal shunt is a valid alternative in patients with preserved liver function that cannot receive a meso-Rex bypass. The postoperative lymphocele is a rare complication in this surgery, but its conservative management with close observation can be sufficient and successful.