Pre- and postoperative imaging and interventions for the meso-Rex bypass in children and young adults

Ian J. Chaves, Cynthia K. Rigsby*, Samantha E. Schoeneman, Stanley T. Kim, Riccardo A. Superina, Tamar Ben-Ami

*Corresponding author for this work

Research output: Contribution to journalReview article

18 Scopus citations

Abstract

The meso-Rex bypass is a physiological and anatomical bypass procedure for relief of extrahepatic portal vein obstruction and restoration of mesenteric venous return to the liver. Most patients who are candidates for the bypass are children or young adults with portal hypertension and hypersplenism secondary to cavernous transformation of the portal vein. Most frequently, the bypass utilizes an autologous venous graft to connect the intrahepatic left portal vein to the infrapancreatic superior mesenteric vein (SMV) re-establishing first-pass portal perfusion. We describe the preoperative imaging of the 92 bypass candidates, the surgical anatomy as reflected in postoperative imaging, and the imaging of bypass complications at our institution. Preoperative imaging with US, CT and MR is directed to demonstrate patency and size of the left portal vein and SMV, to define the extent of cavernous transformation and splanchnic collaterals, and to assess for any associated abdominal vascular or solid organ abnormalities. Postoperative imaging is aimed at diagnosing meso-Rex bypass stenosis or occlusion and the interventional management of these complications.

Original languageEnglish (US)
Pages (from-to)220-232
Number of pages13
JournalPediatric Radiology
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2012

Keywords

  • Cavernous transformation
  • Children
  • Extrahepatic portal vein obstruction
  • Meso-Rex bypass
  • Portal hypertension
  • Rex shunt

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health

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