Outcomes of Proximal Spleno-Renal Shunt Operations for Idiopathic Portal Hypertension in Tertiary Hospital in the Sub-Sahara

Figures & data

Table 1 Socio-demographics and clinical findings of the patients

Patient	1	2	3	4
Age (years/sex)	7/M	16/F	22/M	34/F
Symptoms/signs	Hematemesis Haematochezia Mild abdominal distention Splenomegaly grade 2 Tinge of jaundice Moderate pallor	Hematemesis Melena stools Epigastric tenderness Moderate pallor	Yellowing of eyes x 8 years Right upper quadrant pain x 3 years Hematemesis x 2/52	Melena stools Mild abdominal distention Moderate RUQ + LUQ + epigastric tenderness Splenomegaly
Symptom duration	1 year	1 year	8 years	3 months
Past medical/surgical Hx	3rd episode in 1 year Tabs Propranolol 10 mg od Multiple blood transfusions	2nd episode in 1 year Tabs Propranolol Multiple blood transfusions	Tabs Propranolol Tabs Esomeprazole	Multiple blood transfusions
Pre-op Imaging	Endoscopy: Grade 4 Esophageal varices due to portal HTN Triphasic CT: Portal vein thrombosis	Abdominal Doppler: Portal HTN Endoscopy: Esophageal varices due to portal HTN	Endoscopy: Esophageal varices due to portal HTN Triphasic CT: Extrahepatic portal vein obstruction + portal biliopathy (choledocholithiasis, portal vein calcifications sequelae of previous thrombosis)	Endoscopy: Grade 4 esophageal varices Abdominal Doppler: splenomegaly + portal hypertension with dilated main portal + splenic veins
Provisional diagnosis	Esophageal varices Portal hypertension secondary to portal vein thrombosis	Hypovolemic/haemorrhagic shock secondary to Upper GI bleeding Severe anaemia Extrahepatic portal vein obstruction? Early biliary cirrhosis	Esophageal varices due to portal HTN	Extrahepatic portal vein Obstruction with esophageal varices
Intra-operative findings (Final diagnosis)	Portal vein thrombosis	Extrahepatic portal vein obstruction Multiple collaterals Grade 4 splenomegaly Normal liver	Moderate Ascites + extensive adhesions Extrahepatic portal vein obstruction with portal biliopathy + varices	Normal liver – Non cirrhotic portal HTN + dilated Main portal vein Grade 4 splenomegaly
Surgical intervention	Splenectomy with a proximal splenorenal Shunt on 3rd day of admission	Splenectomy with a proximal splenorenal Shunt on 19th day of admission	Splenectomy with a proximal splenorenal Shunt on 3rd day of admission	Splenectomy with a proximal splenorenal shunt on 2nd day of admission
Immediate post-op complications	None	Surgical site infection (Pus discharging sinus) Sepsis (CRP = 125 mg/l) Malaria (>100mps/hpf + RDT positive)	Portal vein thrombus	Moderate anaemia Hypotension
Length of post - op hospital stay (days)	15 days	8 days	13 days	8 days
Result	Alive 26 months after surgery	Alive 14 months after surgery	Alive 46 months after surgery	Alive 20 months after surgery

Figure 1 Upper GI endoscopy showing grade IV esophageal varices for patient 1 in March 2021.

Figure 2 Follow up upper GI endoscopy for the same patient 1 done in April/2022 after proximal splenorenal shunt surgery, showing complete resolution of the esophageal varices.