Double selective shunting for esophagogastric and rectal varices in portal hypertension due to congenital hepatic polycystic disease

A 55-year-old woman with ascites, pancytopenia. by hypersplenism, recurrent hemorrhagic esophagogastric varices, and large rectal varices due to congenital hepatic polycystic disease underwent splenectomy and simultaneous double selective shunt; a left gastic venacaval direct shunt for esophagogastric varices and a sigmoid venous left ovarian vein shunt for rectal varices. Her preoperative Child-Pugh grade was A (score 6). Postoperative course was uneventful. Serum NH3 level decreased from 90 mug/dL to 36 mug/dL after shunt surgery. She was discharged on the 21st postoperative day. The remarkable improvement of both the esophagogastric varices and the rectal varices was demonstrated by postoperative fiberscope. We strongly consider sigmoid venous left ovarian shunting to be as selective as the Inokuchi shunt preventing encephalopathy and an effective surgical approach to anorectal varices.