Laparoscopic attenuation of a congenital extrahepatic portosystemic shunt in a dog—a thin-film banding for splenophrenic shunt: A case report

Abstract

A 6-year-old castrated male Shih-Tzu dog weighing 6. 5 kg presented with chief complaints of pollakiuria and urine dribbling. He had a history of urolithiasis for 3 years, which was confirmed by the presence of ammonium urate in the urinary stone analysis, performed 2 years prior to the presentation. Blood examination showed high values of fasting ammonia, post-prandial bile acid, and low blood urea nitrogen. Microhepatica and urolithiasis were identified on plain radiography and ultrasonography. A computed tomography angiography demonstrated a shunting vessel, diameter up to 9.6 mm, originated from the splenic vein, and linked with the phrenic vein. A surgical attenuation with a thin-film banding was performed under laparoscopic visualization. Left triangular ligament was incised, and one stay suture was placed to the stomach to expose the vessel. The shunting vessel was dissected before it entered the diaphragm, and a thin-film band was applied around the vessel. The patient recovered uneventfully without post-attenuation neurologic signs. Portal vein diameter increased with time, and complete closure of the shunting vessel was identified on computed tomography angiography performed at 14 months after attenuation. The patient was doing well for 31 months after surgery without protein restriction. This is a report of laparoscopic attenuation for splenophrenic type of canine congenital extrahepatic portosystemic shunt with a favorable outcome using thin-film banding.

Laparoscopic treatment of congenital portosystemic shunts with portal pressure measurement and portal angiography in 36 dogs

“…However, in cases with spleno-phrenic shunts, the shunt vessel begins from the left gastric vein and follows the dorsal stomach to connect with the phrenic vein, which runs through the diaphragm via the lesser stomach curvature. Accordingly, the occlusion site is very short and involves a risk of pneumothorax damaging the diaphragm ( 19 , 21 ). In some cases, detachment of the shunt vessel took a relatively long time.…”

“…In previous studies in which CB or ARC were used in dogs, portal venous pressure measurement and portal angiography were not performed ( 11 – 15 , 19 – 21 ). Instead, the shunt was temporarily occluded with CB, and portal hypertension was monitored by changes in pancreatic and intestinal color and increased peristalsis; CB and ARC are very useful occlusion modalities in dogs that cannot tolerate complete occlusion.…”

“…The cause of shunt remnant in CB attenuated cases has not been clarified, but it has been suggested that misidentification of the shunt or problems with its location may play a role (13.14). Poggi et al reported that intraoperative portal pressure measurement and portovenography are important, despite the challenges associated with these techniques, if possible, for complete occlusion (19)(20)(21)(22)(23)(24). The operative time also tends to increase, thus increasing the burden.…”

“…Various laparoscopic surgery approaches, which are less invasive, less painful, and less inflammatory than open procedures, have been recently reported for dogs ( 16 – 18 ). Nonetheless, there are no reports to date of laparoscopic surgery combining simultaneous portal vein angiography and portal pressure measurement for shunt vessel identification and partial or complete occlusion ( 19 – 24 ). The purpose of this study was to describe the technique, outcomes and complications of LAPSSO combined with portal pressure measurement and portal angiography as well as to evaluate the outcomes and complications.…”

Determination of Bile Acids in Canine Biological Samples: Diagnostic Significance

“…Especially when evaluated postprandially, the serum TBA concentration is a dependable marker for PSS diagnosis with extraordinarily high sensitivity and specificity [187]. However, it is important to consider further aspects.…”