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EHPVO – Rex shunt — RACP Paediatrics MCQ

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HardGIEHPVO – Rex shuntRACP Paediatrics

A 6-year-old with extrahepatic portal vein thrombosis (EHPVO) and normal liver function has recurrent variceal bleeding despite endoscopic treatment. What is the most appropriate definitive surgical intervention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Rex shunt (mesenterico-left portal vein bypass)

Rex shunt (mesenterico-left portal vein bypass/Meso-Rex shunt) is the preferred surgical option for EHPVO with normal liver parenchyma. It restores physiological portal venous flow to the liver, resolving portal hypertension and its complications. Candidacy depends on the patency of the intrahepatic left portal vein (assessed by imaging).

Reference: RACP Paediatric Curriculum – GI; RCH Melbourne – 2023 – Portal Hypertension CPG