Closure of interposition mesocaval shunt in a case of idiopathic portal hypertension.

Interposition mesocaval shunt for hemorrhagic esophageal varices was carried out in a patient with idiopathic portal hypertension without preoperative hepatic dysfunction. The esophageal varices were controlled, but the hemodynamics of the portal vein subsequently underwent gradual change and attacks of hepatic encephalopathy occurred frequently the following year. Therefore, the shunt was closed after about 2 yr. Hepatic encephalopathy disappeared after this surgery, but the varices obviously worsened on the 5th postoperative day and bled spontaneously on the 33rd postoperative day. A distal splenorenal shunt constructed 35 days after the operation resulted in the reduction, but not the complete disappearance, of esophageal varices. Episodes of hepatic encephalopathy or bleeding from the esophageal varices were not observed in the 24 months following the second shunt surgery.