Bangladeshi child receives Meso-Rex portal vein bypass at West China Hospital
A four-year-old travelled to Chengdu after repeated digestive bleeding; several specialties coordinated vascular assessment, surgery and discharge planning.
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West China Hospital of Sichuan University has reported treatment of a four-year-old Bangladeshi girl with cavernous transformation of the portal vein and portal hypertension. Her parents brought her to the emergency department on March 3, 2026, after more than five months of repeated vomiting of blood and black stools.
Evaluation after travelling to Chengdu
The child had previously undergone endoscopic banding for bleeding oesophageal and gastric varices in Bangladesh, but the underlying portal hypertension persisted. Investigations in Chengdu showed extensive collateral vessels, severe enlargement of the spleen and marked varices, alongside low platelets and abnormal coagulation.
Paediatric surgery consulted liver transplantation, gastroenterology, vascular surgery, anaesthesia, imaging, ultrasound and intensive care specialists. The team chose a Meso-Rex bypass to restore blood flow into the liver across the obstructed portal segment.
Imaging and microsurgical reconstruction
Ultrasound, three-dimensional CT vessel reconstruction and venography mapped the vessels. The left portal branch measured just four millimetres, making the available route for reconstruction particularly small.
Surgery took place on March 10. After anaesthetic preparation, venography through femoral access confirmed the left branch and intrahepatic branches were suitable. Vascular surgeons harvested approximately six centimetres of the child’s right internal jugular vein for the graft.
Paediatric and liver transplant surgeons then used microsurgical suturing to connect the bypass between the superior mesenteric vein and left portal branch. The operation lasted 10 hours and 17 minutes, with recorded blood loss of 150 millilitres. Intraoperative ultrasound and postoperative CT angiography showed blood flowing through the reconstructed vessel.
Recovery and a specific follow-up plan
Intensive care and paediatric teams monitored the child and organised nutrition, medication and rehabilitation care. She was discharged on postoperative day 12, with no reported fever, abdominal pain or black stools and with satisfactory eating and sleeping.
For this child, the discharge instructions specified six months of prescribed oral anticoagulation and regular blood counts, liver function and coagulation tests, together with imaging follow-up. The team explained these arrangements to her family before discharge.