Inferior Mesenteric Vein-Caval Shunt for Extrahepatic Portal Venous Obstruction With Portal Cavernomatous Cholangiopathy: A Hobson’s Choice

Proximal splenorenal shunt is the most commonly performed shunt in patients with extrahepatic portal venous obstruction (EHPVO). Sometimes, due to various anatomical and intraoperative factors, other rarely used shunts may be required. We present the case of a 27-year-old male who was diagnosed with EHPVO with complicated portal cavernomatous cholangiopathy. He had thrombosis of the entire extrahepatic portal vein, splenic vein, and superior mesenteric vein. An unconventional side-to-side inferior mesenteric vein (IMV) to inferior vena cava (IVC) shunt was performed. The patient had a chyle leak in the postoperative period, which was managed conservatively. Sixteen months after shunt surgery, the patient had no further bleeding, with a resolution of cholangiopathy, and is currently without any endobiliary stent. The IMV-caval shunt is a feasible and safe makeshift shunt with a good long-term outcome in the absence of a shuntable splenic vein.