Effectiveness of Rex shunt in the treatment
of portal hypertension
, Eve Roberts
, Riccardo A. Superina
, Peter C. Kim
Department of Surgery and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada M5X 1X8
Division of Pediatric Surgery, Children’s Memorial Hospital, Chicago, IL 60614, USA
Background: Children with portal venous thrombosis often have severe symptoms secondary to portal
hypertension including recurrent upper gastrointestinal (UGI) bleeds and hypersplenism. We report
results of the use of the mesenterico–left portal bypass (Rex shunt) in 5 consecutive patients.
Methods: A retrospective chart review of all patients with portal venous thrombosis who underwent Rex
shunt procedure was performed. Children were evaluated preoperatively with magnetic resonance
angiogram, Doppler ultrasound, and mesenteric angiogram. Postoperative ultrasounds were performed
Results: All patients had evidence of portal hypertension and hypersplenism. The average age of the
patients was 13.2 F 4.9 (7-19) years. The patient had an average of 2.6 F 1.7 UGI bleeds requiring
banding and 3.4 F 4.2 U of blood transfused before undergoing the shunt. The mean operative time
was 383 F 46 minutes, and length of stay was 10.4 F 7.1 days. In follow-up of 18.8 F 5.2 months
(11-24 months), all but 1 patient had a patent shunt. One narrowed shunt was successfully dilated by
percutaneous angioplasty. Thrombocytopenia improved significantly in patients with functioning shunts
but did not correlate with a significant decrease in splenic size.
Conclusions: The Rex shunt reestablishes normal hepatopedal portal flow, and in patients with
functioning shunts, no recurrent UGI bleeds or transfusions were required or evidence of encephalopathy
D 2006 Elsevier Inc. All rights reserved.
Extrahepatic portal venous thrombosis (PVT) in children
is an increasingly reported phenomenon . Often these
children are premature and have a history of umbilical
venous catheterization . Children with PVT often develop
symptomatic extrahepatic portal hypertension. Generally,
liver function is maintained in these patients, unlike those
children with portal hypertension caused by liver parenchy-
mal diseases [1,3]. These children present with significant
upper gastrointestinal (UGI) bleeding, often requiring
sclerotherapy or variceal banding as well as thrombocyto-
penia secondary to hypersplenism.
Surgical treatment is often considered in patients who
have an ongoing need for transfusion, endoscopic proce-
dures, and/or hypersplenism. Treatment of portal hyperten-
sion can include gastric devascularization procedures,
Warren Shunt (distal splenorenal shunt) portosystemic
shunts, or the mesenterico–left portal venous bypass (Rex
shunt). The Rex shunt uses autologous vein graft, classically
the left internal jugular vein, and extends from the superior
0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
Presented at the 36th Annual Meeting of the American Pediatric
Surgical Association, Phoenix, AZ, May 29-June 1, 2005.
* Corresponding author.
E-mail address: firstname.lastname@example.org (P.C. Kim).
Portal venous thrombosis
Journal of Pediatric Surgery (2006) 41, 108 – 112