Abstract
A 47-year-old man with idopathic portal hypertension was admitted to our hospital for the management of recurrent bleeding esophageal varices. He had undergone total gastrectomy and esophagojejunostomy with the loope type reconstruction like the Billroth II because of bleeding esophago-gastric varices 10 years before. Injection sclerotherapy failed to control recurrent bleeding of the varices. Bleeding continued from the site of esophagojejunal anastomosis. The ligation of the vein of a jejunal segment which is ascending to the esophagus was done at the first operation. Bleeding was controlled for only ten months. But variceal bleeding occurred again. As the second operation, the vein of the ascending jejunal segment was anastomosed to the left renal vein with the disconnection from the portal vein. The patient died of amyotrophic lateral sclerosis 55 months after the shunt operation. The autopsy showed that the shunt was patent. Encephalopathy was not encountered after the operation. It is considered that total gastrectomy should be avoided for esophageal varices as possible as it allows, but if the varices recurs after total gastrectomy, this new selective shunt procedure may be recommended.
