{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T10:01:13Z","timestamp":1771581673484,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Extrahepatic portal vein obstruction (EHPVO) accounts for more than two thirds of pediatric portal hypertension. Rex shunt is the preferred surgical management, as it restores hepatopetal flow and minimizes or reverses liver dysfunction. Case Summary: We report surgical treatment of EHPVO in a 9-year-old girl using portal-Rex shunt with internal jugular vein (IJV) as a conduit and the intact proximal main portal vein instead of the superior mesenteric vein as a venous inlet. Improvement in thrombocytopenia and reduction in splenic size were achieved post-operatively. The portal-Rex shunt remains patent with good hepatopetal flow at one year post-operation. Conclusions: The success of a portal-Rex shunt to selectively bypass EHPVO rests upon careful selection of inlet and outlet veins, as well as a conduit with good patency, such as the IJV.<\/jats:p>","DOI":"10.3390\/children13020291","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T08:50:03Z","timestamp":1771577403000},"page":"291","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Portal-Rex Shunt Using Patent Proximal Main Portal Vein as Venous Inflow and Internal Jugular Vein as Conduit"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2694-1581","authenticated-orcid":false,"given":"Irene Wen Hui","family":"Tu","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, National University Hospital, Singapore 119074, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1816-9862","authenticated-orcid":false,"given":"Yang Yang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, National University Hospital, Singapore 119074, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5328-7920","authenticated-orcid":false,"given":"Vidyadhar Padmakar","family":"Mali","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, National University Hospital, Singapore 119074, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/BF02730901","article-title":"Portal Hypertension in North Indian Children","volume":"65","author":"Arora","year":"1998","journal-title":"Indian J. Pediatr."},{"key":"ref_2","first-page":"42","article-title":"Aetiology of Paediatric Portal Hypertension\u2014Experience of a Tertiary Care Centre in South India","volume":"39","author":"Simon","year":"2009","journal-title":"Trop. Dr."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zhang, J., and Li, L. (2022). Rex Shunt for Extra-Hepatic Portal Venous Obstruction in Children. Children, 9.","DOI":"10.3390\/children9020297"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"186","DOI":"10.5758\/vsi.200018","article-title":"Standard or Variant Meso-Rex Shunts for Children with Variceal Bleeding Due to Extrahepatic Portal Vein Obstruction: A Report of Two Cases","volume":"36","author":"Oh","year":"2020","journal-title":"Vasc. Spec. 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Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S0022-3468(98)90324-4","article-title":"Direct Bypassing of Extrahepatic Portal Venous Obstruction in Children: A New Technique for Combined Hepatic Portal Revascularization and Treatment of Extrahepatic Portal Hypertension","volume":"33","author":"Alberti","year":"1998","journal-title":"J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1016\/j.jamcollsurg.2016.03.020","article-title":"A New Procedure for the Treatment of Extrahepatic Portal Hypertension in Children: Portal Cavernoma-Rex Shunt with Interposition of Grafted Portal Vessel","volume":"222","author":"Zhang","year":"2016","journal-title":"J. Am. Coll. 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Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"100197","DOI":"10.1016\/j.iliver.2025.100197","article-title":"From Thrombosis to Transplantation: The Role of Anti-Phospholipid Antibodies in Liver Disease Management","volume":"4","author":"Pallotta","year":"2025","journal-title":"iLIVER"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/291\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T09:02:12Z","timestamp":1771578132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["children13020291"],"URL":"https:\/\/doi.org\/10.3390\/children13020291","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}