Long‐term results of variceal bleeding management in 302 patients with chronic extrahepatic portal vein obstruction

2019 ◽  
Vol 35 (6) ◽  
pp. 1049-1056 ◽  
Author(s):  
Hui Chen ◽  
Chuangye He ◽  
Yong Lv ◽  
Jiahao Fan ◽  
Shihao Tang ◽  
...  
Keyword(s):  
Portal Vein ◽  
Variceal Bleeding ◽  
Long Term Results ◽  
Extrahepatic Portal Vein Obstruction ◽  
Bleeding Management ◽  
Portal Vein Obstruction

Long-Term Results after Diversion Surgery in Extrahepatic Portal Vein Obstruction

2018 ◽  
Vol 29 (01) ◽  
pp. 023-027 ◽  
Author(s):  
Ana Alvarez ◽  
Mariela Dore ◽  
Javier Jimenez Gomez ◽  
Alba Sánchez Galán ◽  
Alejandra Vilanova-Sánchez ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Statistical Significance ◽  
Long Term Results ◽  
Spleen Size ◽  
Extrahepatic Portal Vein Obstruction ◽  
Prothrombin Activity ◽  
Portal Vein Obstruction ◽  
Bleeding Episodes

Aim Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. Patients and Methods Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activity, splenomegaly, and gastrointestinal bleeding 10 years after surgery. Results Thirty-three patients were evaluated, mostly males (64%) and presenting with gastrointestinal bleeding (46%). Mesoportal shunt (Rex) was performed in 19 patients, mesocaval in 7, distal splenorenal in 7, and proximal splenorenal in 3. While comparing mesoportal shunt to the other portosystemic shunts, an increase in platelets was found with every technique, but it was clearly higher in mesoportal shunt. The highest increase was 6 months after surgery (p = 0.0015) as well as prothrombin activity (p = 0.0003). Leukocytes level also increased without statistical significance. Spleen size (cm) and spleen size Z score (SSAZ) decreased significantly 6 months after mesoportal shunt (p = 0.0168). Before surgery, over 94% patients suffered gastrointestinal bleeding, which reduced significantly afterward with bleeding episodes in only four (12%) of them. Conclusion Diversion surgery in EHPVO, especially mesoportal shunt of Rex, improves hepatic function (prothrombin activity), reduces hypersplenism (platelets, leukocytes, and spleen size), and decreases gastrointestinal bleeding episodes.

Long-term follow-up of children with extrahepatic portal vein obstruction: impact of an endoscopic sclerotherapy program on bleeding episodes, hepatic function, hypersplenism, and mortality

2009 ◽  
Vol 44 (10) ◽  
pp. 1877-1883 ◽  
Author(s):  
João Gilberto Maksoud-Filho ◽  
Manuel Ernesto Peçanha Gonçalves ◽  
Silvia Regina Cardoso ◽  
Nelson Elias Mendes Gibelli ◽  
Uenis Tannuri
Keyword(s):  
Portal Vein ◽  
Hepatic Function ◽  
Endoscopic Sclerotherapy ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Long Term Follow Up ◽  
Bleeding Episodes

scholarly journals Unusual Tumors Causing Extrahepatic Portal Venous Obstruction

HPB Surgery ◽  
1996 ◽  
Vol 9 (3) ◽  
pp. 165-167 ◽  
Author(s):  
B. C. Sharma ◽  
V. A. Saraswat ◽  
R. K. Dhiman ◽  
U. C. Ghoshal ◽  
A. S. Puri ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Bile Ducts ◽  
Venous Obstruction ◽  
Extrahepatic Portal Vein Obstruction ◽  
Extrahepatic Portal Venous Obstruction ◽  
Portal Vein Obstruction ◽  
Vascular Infiltration ◽  
Gastric Leiomyosarcoma

Extrahepatic portal vein obstruction has been reported to be associated with tumors of liver, bile ducts and pancreas. We report two cases, one with gastric leiomyosarcoma and another with Non Hodgkin’s lymphoma, complicated by portal vein block and presenting with gastric variceal bleeding. Portal vein block in both cases was due to direct vascular infiltration. Development of portal hypertension posed difficulties in management.

Splanchnic vein closures

2019 ◽  
Vol 98 (6) ◽  
pp. 239-244
Keyword(s):  
Portal Vein ◽  
Surgical Approach ◽  
Medical Problem ◽  
Budd Chiari Syndrome ◽  
Extrahepatic Portal Vein Obstruction ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Portal Vein Obstruction ◽  
Chiari Syndrome ◽  
Outflow System

Closures in the splanchnic venous system (SVS) represent a broad medical problem. Anatomically, individual or even multiple sections of SVS may be affected at the same time. Main sections of SVS include the venous liver outflow system, the portal vein, and the upper mesenteric vein and its basin. Thrombosis is clearly the predominant cause of closure. The closures can present as acute, subacute, chronic occult or chronic manifest. The main pathological and anatomical units are the Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO) and mesenteric vein thrombosis (MVT). Advanced laboratory, imaging and intervention methods substantially modify the approach to prevention, diagnosis and treatment; surgical approach also plays a role. The problem of SVS closures is interdisciplinary.

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: A 10-year experience

2008 ◽  
Vol 23 (11) ◽  
pp. 1702-1709 ◽  
Author(s):  
Tomohiko Akahoshi ◽  
Makoto Hashizume ◽  
Morimasa Tomikawa ◽  
Hirofumi Kawanaka ◽  
Shohei Yamaguchi ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Gastric Varices ◽  
Long Term Results
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