Surgical Occlusion with Cellophane Bands Methods in Congenital Extrahepatic Portocaval Shunt
S. Yeongsik; H. So
Department of Surgery, Chonbuk National University, Iksan, Republic of Korea
Surgical intervention has been recommended for congenital portosystemic shunt in dogs, but acute complete ligation of shunt is associated with life-threatening portal hypertension. To reduce the risk of portal hypertension, gradual vascular occlusion is needed. The use of cellophane bands incites inflammatory reactions associated with a chronic foreign body and leads to gradual occlusion of shunted vessel.
To report outcome after cellophane banding of single congenital portosystemic shunt in a 4-month-old dog.
On radiography, microhepatica with smooth margination was observed. On computed tomography, there was shunt vessel from portal vein to CdVC. On laboratory test, serum ammonia level was 76 μmol/L. ALP, AST, and GGT levels were elevated and ALB, BUN, CREA levels were decreased.
Based on these results, it was diagnosed as congenital portosystemic single shunt. As a treatment, surgical occlusion of shunt was performed followed by 2 weeks medical management with hepatoprotective therapy, antibiotics and oral lactulose.
The patient had a ventral median celiotomy and surgical time was 50 minutes. Portosystemic shunt which entered CdVC from portal vein was identified by abdominal exploration. Cellophane bands were placed as reported previously. The patient was monitored intensively for 48 hours after surgery to observe for postligation neurologic dysfunction or portal hypertension.
Two weeks after surgery, neurologic dysfunction of patient was recovered and postoperative serum ammonia concentration was decreased to 18 μmol/L. There were no complications associated with surgical shunt attenuation without recurrence of clinical signs.
Cellophane banding is a safe and effective alternative to ameroid constrictors methods of attenuation for large portosystemic shunt.