Actual Case Report Regarding the Rex Shunt Procedure (Adults)

In the last decade, the Rex Shunt procedure has been successfully performed on children with portal vein thrombosis, however to the best of my knowledge has not been performed on adults with the exception of one person which I found had the operation in Niigata, Japan. The following article (click link below) was posted by a group of Japanese doctor’s who had successfully performed the Rex Shunt Procedure on an adult male a few year’s ago. Although the article is technical in nature, nonetheless I hope you are able to glean some good information from it?

It is interesting to note that this group of Japanese doctor’s are recommending the Rex shunt procedure be performed on a larger scale for adults with portal vein thrombosis.

This article begs the question of whether or not there is general consensus amongst gastroentrologists and other specialists that this procedure is even a viable option for patients with PVT. Cost factor’s and risks versus gains would likely weigh into the equation also? This being said I would really appreciate input from anyone, especially doctor’s as the report above and a recent statement (see below) from Dr. Riccardo Superina (Children’s Memorial Hospital Chicago, IL) support the procedure be performed on adults.

“There is no reason that it cannot be applied to adults, and we would be happy …to hear their cases if they wished to send case summaries along and recommend further investigation or action.”

30 thoughts on “Actual Case Report Regarding the Rex Shunt Procedure (Adults)

  1. Janet

    Clint and Chantalle. It’s been 3 years since the last post so I’m not sure if this blog is monitored or not. I had my portal thrombosis event 10 years ago and my portal vein doesn’t work nor exist any more. I have cavenerous veins which carry the blood flow but there isn’t enough capacity. I have portal hypertension and varicose veins by my stomach, esphogous, and intestines and take non-selective blood pressure RX to lower pressure. I haven’t had any additional complications for the last 10 years. More background: my gallbladder was removed years ago and I have experienced chronic stomach issues to include gastritis and the gallbladder removal made my stomach and IBS issues worse. I have splenonomegally after the PVT. Between the large spleen, stomach issues, IBS, and gallbladder removal I now have more issues with digestion, anemia, poor nutrient absorption, and low platelet counts. The last month I’ve had 3 ER visits due to intense pain at the bottom of the breast bone. I don’t know if this is a new PVT complication. Completed extensive heart testing that has been ruled out. Completed dopular scan and CT scan and didn’t find any new issues. Next week I have an endoscope to verify there isn’t anything new in my stomach or the varicose veins.

    1. Clint Post author

      Thanks Janet for your note. Yes I do monitor this blog, but not as often as I should! I am very sorry to hear of your issues, and I certainly can relate to some of the complications you have experienced. I was intrigued to hear that you had your gallbladder removed, as my doctors have all warned me that it is very dangerous for me using any method for the fear of hemorrhaging in the midst of the procedure. I am bothered by severe pain every once in awhile, and apparently there are several stones in there, however I have take a medication called Ursodiol with is supposed to break down the stones. If an infection every develops…well I try not to think about that. I take allot of supplements besides my prescribed medications, which are many, but I’m thinking that maybe this is something that could be beneficial to you also? In particular I have found that acidophilus and probiotics are helpful in digestion, and maybe those could help? I also take Omega 3, vitamin B50, Vitamin D, and Zinc. I am sure you are relieved to know that there was no heart issues, but I am wondering what if anything the endoscope revealed? Thanks again for the update…I hope you are feeling better?

  2. de Ville de Goyet Jean

    Meso-Rex shunt can be done in adults, yes.
    First case in 1998 – published in a national paper as it was refused by all adult surgical journals…
    de Ville de Goyet J, Martinet JP, Lacrosse M, Goffette P, Melange M, Lerut J. Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension. Acta Gastroenterol Belg. 1998;61(1):13-16.

    The procedure is a bit more demanding as these patients often comes very late in their disease, with advanced portal hypertension and thickening of mesentery. The distance between the Rex and the superior mesenteric vein is also relatively longer (in proportion to their jugular vein) than in children.
    Cases are rare for a series of reasons – including that they are hardly referred to the surgeon – and one of the problem is to make the “adult world” aware of that solution.
    I have done a dozen of cases and tried a few time to publish these cases – but this is matter that dont pass review process…

    1. Clint Post author

      Dear Dr. Goyet,

      Thank you for your added comments to my blog. Your words pointing to adults with the condition also provide hope. I am hoping someone will see this and possibly get in touch with you, and in turn seek you out for resolution to their particular case.



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