PHẪU THUẬT TẠO THÔNG NỐI “MESO-REX”: BÁO CÁO TRƯỜNG HỢP LÂM SÀNG VÀ MÔ TẢ CHI TIẾT KỸ THUẬT

Abstract

Introduction: Extrahepatic portal vein obstruction (EHPVO) is a significant cause of portal hypertension in children. When the intrahepatic portal system remains intact, the Meso-Rex bypass is considered the standard treatment. In Vietnam, there are few reports on this condition, and no publications have detailed a comprehensive surgical technique. Patient and Methods: This report presents a successfully treated case using the Meso-Rex bypass. The diagnostic approach and surgical technique are described in detail. Results: A 7-year-old girl was admitted with hematemesis. Clinical examination revealed anemia and grade 3 splenomegaly. Laboratory results showed Hb 7.0 g/dL, platelet count 68,000/μL, and coagulopathy (PT 19.3s, INR 1.6). The patient was stabilized with somatostatin and packed red blood cell transfusion. Tests for protein C, protein S, and Factor V-Leiden were within normal limits. Contrast abdominal CT scan showed portal vein trunk thrombosis and cavernous transformation, with splenomegaly but no hepatic fibrosis or mass lesions. During a single anesthesia session, upper gastrointestinal endoscopy was performed (with variceal banding) and retrograde portography was conducted, confirming an intact intrahepatic portal system and a visible Rex. Meso-Rex shunt surgery was indicated and performed using the left internal jugular vein as a graft. Operative time was 270 minutes with an estimated blood loss of 50 ml. The shunt was patent and functional in the early postoperative period and remained satisfactory flow at 24-month follow-up, with velocities of 20–24 m/s. Conclusion: Retrograde portography is a crucial technique for evaluating the intrahepatic portal system and determining surgical eligibility for Meso-Rex bypass. Despite its technical complexity, the procedure restored physiological portal flow and yielded high treatment efficacy when properly indicated and performed.