Gastrorenal and mesenterorenal shunts

Case contributed by Heba Abdelmonem
Diagnosis almost certain

Presentation

Long term history of hepatitis C virus.

Patient Data

Age: 55 years
Gender: Male

On the left side, gastric varices drain into a dilated left renal vein forming a gastrorenal shunt.

On the right side, mesenteric varices carry blood from the superior mesenteric vein (SMV) into the right renal vein.

The liver is cirrhotic with an enlarged spleen. Incidental finding of intramuscular lipoma at the left posterior abdominal wall.

Case Discussion

Gastric varices usually drain into the azygos system via esophageal or paraesophageal veins. Less commonly, they drain into the left renal vein through a gastrorenal shunt. 

Mesenteric collateral presents with vascular channels that carry the blood from the superior mesenteric vein into the systemic circulation via the retroperitoneal venous plexus, or in some cases a mesenterorenal shunt develops in the form of a connection between the superior mesenteric vein and the right renal vein.

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