Meso-Rex bypass to manage prehepatic portal hypertension after the failure of an intrahepatic portosystemic stent shunting

A cavernomatous transformation of the extrahepatic portion of the portal vein is a common cause of chronic portal hypertension in children. A few attempts at radiological interventions have been reported, but have rarely been successful. In this report, a surgical Meso-Rex bypass was performed to treat complicated prehepatic portal hypertension, after the insertion of an intrahepatic stent for portosystemic shunting had failed. The review of this case nicely illustrates how differently effective are these two shunting procedures—in terms of restoring hepatopetal flow, managing portal hypertension, and establishing—or not—portosystemic connections.