Compartmentalized gastrosplenic and mesenteric venous hypertension after distal splenorenal shunt occlusion: response to mesocaval shunt and splenectomy.

This is a report of a patient with a thrombosed Warren shunt and recurrent variceal hemorrhage who demonstrated compartmentalized venous hypertension in the mesenteric and gastrosplenic systems. Although the mesenteric presssure was normalized by the construction of a mesocaval interposition shunt, the gastrosplenic venous pressure remained elevated until splenectomy was performed. Warren shunt occlusion should be considered as a cause of segmental portal hypertension. Splenectomy may be a necessary adjunct in patients suitable for reshunting.