Early hepatic failure or upper gastrointestinal bleeding following a distal splenorenal shunt.

Hepatic failure and upper gastrointestinal bleeding following a distal splenorenal shunt is distinctly unusual. Should either or both of these complications develop in the immediate or early postoperative period, adequate angiographic studies should be done without delay so as to identify accurately the status of the portal and splenic venous systems. If an unligated coronary vein is apparent, transhepatic clotting should be accomplished. The presence of other major collateral vessels between the portal and splenic circulations may require surgical ligation. The presence of thrombosis of the portal vein represents a more serious problem, with thrombectomy and arterialization of the portal vein offering the best chance for survival in a patient with a deteriorating condition.