Variceal rebleeding after portosystemic shunting: Strategies and solutions to a vexing problem

Portosystemic shunting continues to be the mainstay of treatment for variceal hemorrhage secondary to cirrhosis and portal hypertension. Should the shunt fail, rebleeding is often severe, necessitating prompt control and resuscitation. Although attempts to re-establish shunt patency with angiographic techniques may prove fruitful, operative decompression in a previously untouched area of the portal system may become necessary. If these options are available, repeated endoscopic sclerotherapy beomes the best remaining alternative.