ObjectiveThe authors evaluated the clinical significance of the development of reversed portal flow after abdominal surgery other than portosystemic shunt procedure.
Summary Background DataThere have been several reports in regard to reversed portal flow demonstrated by pulsed Doppler ultrasonography, most of which were related to portal hypertension. To the authors' knowledge, this is the first report in which reversed portal flow also is present in patients who have undergone abdominal surgery other than portosystemic shunt procedure.
MethodsPreoperative and postoperative pulsed Doppler ultrasonographic examinations were performed in 126 patients who underwent abdominal surgery. Postoperatively, the portal flow direction was assessed in the right portal branch or the umbilical portion of the left portal branch.
ResultsOf the 126 patients, reversed portal flow developed in 10 after surgery; 9 of them died of liver failure.
ConclusionsThe postoperative development of reversed portal flow is considered to have grave prognostic significance, indicating that the degree of postoperative liver damage is extremely critical.It is well known that portal flow direction can easily be altered when the gradient of portal venous pressure is reversed, because the portal venous system is a circulatory system without valves. There have been many reports ofhepatofugal flow in the portal vein under various conditions.11 1 In the course of our observations of postoperative changes in portal hemodynamics using pulsed Doppler ultrasonography, we encountered ten patients in whom the portal flow direction changed from hepatopetal to hepatofugal after abdominal surgery other than portosystemic shunt procedures. Critical liver dysfunction developed subsequently in all except one. As far as 370
