A 42-year-old man with portal hypertension secondary to cirrhosis of the liver and
subsequent massive ascites presents to the emergency department. He refuses to have a
transjugular intrahepatic portosystemic shunt (TIPS) procedure and prefers surgery.
Which of the following surgical connections is involved in the most practical method of
shunting portal blood around the liver?
(A) Superior mesenteric vein to the inferior
mesenteric vein
(B) Portal vein to the superior vena cava
© Portal vein to the left renal vein
(D) Splenic vein to the left renal vein
(E) Superior rectal vein to the left colic vein
The answer is D. Portal hypertension can be reduced by diverting blood from the portal to
the caval system. This is accomplished by connecting the splenic vein to the left renal vein
or by creating a communication between the portal vein and the IVC. A connection
between a hepatic vein and a branch of the portal vein can be accomplished by the transjugular
intrahepatic portosystemic shunt (TIPS) procedure in the treatment of bleeding
esophageal varices.