A 21 year old woman underwent a mesotrial shunt for intractable ascites, liver failure, and angiographic evidence of hepatic venous thrombosis. During the preceding month, she had been explored for ovarian cyst, had a subsequent Le Veen peritoneal-jugular shunt fail, and had thrombosis of a portal-renal shunt. At operation, subacute superior mesenteric venous thrombosis required thrombectomy. A 12mm externally-supported polytetra-fluoroethylene graft was placed between the superior median sternotomy and midline abdominal incision. The mesenteric venous pressure was reduced from 21 to 12 cm water. The patient recovered uneventfully and has been well for seven years.