A case with large hepatoma which showed some interesting findings of the hemodynamics of the portal system after interposition mesocaval shunt

Abstract

A 63-years old woman was admitted to our hospital because of severe jaundice. Five years ago, an interposition mesocaval shunt operation was performed because of bleeding from esophageal varices. US and CT detected a large hepatic tumor. Hepatic catheterization was performed. The blood flow volume was measured by an ultrasonic duplex system, and blood pressure was measured simultaneously in the portal venous system. Pressure gradient of the shunt was 6 mmHg and its blood flow was about 3, 000 ml/min. It was proved that the vascular resistance was very low. It was found that the portal blood flow had been reversed. But we suspected sufficient blood flow through the hepatic sinusoid. The high sinusoidal pressure was maintained by both the high portal vein and high inferior vena cava pressures, which were caused by an obstruction of the inferior vena cava from the growth of the hepatic tumor.