Abstract
Purpose of the study - to study influence of portosystemic shunting on renal hemodynamics in children with portal hypertension. A retrospective analysis of 152 portosystemic shunting operations performed. Impact of portosystemic shunting on renal hemodynamics analyzed by ultrasound Doppler of renocaval segment, multislice computed tomography and magnetic resonance imaging angiography of abdominal aorta. The most frequently we performed proximal splenorenal anastomosis with splenectomy (61.1%). Signs of renal venous hypertension in patients with prehepatic portal hypertension detected in 13 (8.5%) patients. In 9 (5.9%) cases, the cause was congenital anomalies of renocaval segment, most of which (n=7) circumaortic left renal vein. Inadequate reduction of esophageal varices after portosystemic shunting was observed in 6 (46%) of 13 patients with symptoms of renal venous hypertension. However, only 1 patient with circumaortic left renal vein due to thrombosis of distal splenorenal shunt reoperated - mesocaval bypass. Portosystemic shunt operation using the anomalous left renal vein can cause unsatisfactory results with the development of rebleeding from esophageal varices. Besides a large amount of blood drained from the portal system in to left renal vein can induce nutcracker phenomenon, and as a consequence the development renal venous hypertension.
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