Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism

Introduction. Extra-hepatic portal vein obstruction (EHPVO) is one of the most often causes of portal hypertension in children. Objective. Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomegaly and severe hypersplenism. Methods. Distal splenorenal shunt (DSRS) with partial spleen resection was performed in 22 children age from 2 to 17 years with EHPVO. Indications for surgery were pain and abdominal discomfort caused by spleen enlargement, as well as symptomatic hypersplenism with leucopenia, thrombocytopenia and anemia. The partial spleen resection was performed by ligation of blood vessels to caudal two thirds of the spleen. After ischemic parenchymal demarcation transection with electrocautery LigaSure was performed with preservation of 20-30% of spleen tissue, and then Warren DSRS was created. Platelet and leucocytes counts and liver function tests were obtained before, one month and one year after surgery. Growth was assessed with SD scores (Z scores) for height, weight and body mass index at the time of surgery and one year later. Results. In all patients postoperative period was without significant complications. Platelets and leucocytes counts were normalized. Patency rate of shunts was 100%. Two significant shunts stenosis were observed and successfully treated with percutaneous angioplasty. During the follow-up period (1 to 9 years) all patients were asymptomatic, with improved quality of life and growth. Conclusion. Results of our study indicate that shunt surgery with a partial spleen resection is an effective and safe procedure for patients with enormous splenomegaly and severe hypersplenism caused by EHPVO.

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Growth assessment in children with extra-hepatic portal vein obstruction and portal hypertension

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032003000400009 ◽

2003 ◽

Vol 40 (4) ◽

pp. 247-250 ◽

Cited By ~ 14

Author(s):

Maria Angela Bellomo-Brandão ◽

André Moreno Morcillo ◽

Gabriel Hessel ◽

Silvia Regina Cardoso ◽

Maria de Fátima P. C. Servidoni ◽

...

Keyword(s):

Body Mass Index ◽

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Obstruction ◽

Z Scores ◽

Hepatic Portal Vein ◽

The Mean ◽

Hepatic Portal ◽

Height For Age ◽

Weight For Age

BACKGROUND: Several studies carried out to examine the growth of children with extra-hepatic portal vein obstruction and portal hypertension have reported a variety of findings. AIM: To assess anthropometric indices in children with portal hypertension due to extra-hepatic portal vein obstruction and who were treated by endoscopic variceal sclerotherapy. METHODS: Anthropometric data were obtained retrospectively from the medical records of 24 patients who had been followed for 3.8 ± 2.5 years at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital, Campinas, SP, Brazil. The mean Z scores of weight for age, height for age and body mass index at diagnosis and at the last consultation were compared to reference data of the National Center for Health Statistics. The two recordings were compared to assess the long-term effect of the condition. RESULTS: The mean Z scores at diagnosis and at the last follow-up visit were all within normal ranges when compared to the reference population, with the following respective values: weight for age, 0.042 ± 1.09 and 0.132 ± 1.29; height for age, 0.200 ± 1.04 and 0.466 ± 1.24, and body mass index, -0.223 ± 0.98 and -0.198 ± 0.98. In addition, there were no significant differences between the Z score values obtained in the two recordings. CONCLUSION: Portal hypertension due to extra-hepatic portal vein obstruction was not associated with growth impairment in the group of children studied.

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Evaluate the role of endoscopy and ultrasonography in patients of portal hypertension

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194747 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2646

Author(s):

Ghanshyam Das ◽

Shweta Gautam ◽

Vijay Pal

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Liver Diseases ◽

Chronic Liver ◽

Chronic Liver Diseases ◽

Portal Vein Obstruction ◽

Hepatic Portal Vein ◽

Hepatic Portal ◽

Severe Grade

Background: Aim of the study was to evaluate the role of endoscopy and ultrasonography in pediatric patients suffering from portal hypertension .subjects: children under 12 years of age hospitalized with any symptom or sign suggestive of portal hypertension.Methods: The study was conducted in 30 children with portal hypertension. They were divided into two groups on the basis of site of lesion: extrahepatic (extra hepatic portal vein obstruction) and intrahepatic (chronic liver diseases).Results: Mean age of children with EHPVO (extra hepatic portal vein obstruction) was 4 years and 4 months while that of children with CLD (chronic liver diseases) mean age was 8 years and 4 months. Endoscopic findings in patients with EHPVO have severe grade of varices as compared to those with CLD. In patients with EHPVO, the most common USG finding was nonvisualisation of the main portal vein or either branch (75-85%). Portal vein cavernoma was seen in 75% of these patients. Portosystemic collaterals were visualized in 23 patients in which the left gastric collateral (60%) was the most common followed by short gastric collaterals in 11 children (55%).Conclusions: Endoscopy and ultrasonography are new and better modalities to assess the diagnosis and severity of portal hypertension. Extra hepatic portal vein obstruction is the commonest cause followed by intrahepatic obstruction (Chronic liver diseases).

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A Bypassing Technique for the Remedy of Portal Hypertension through Extra Hepatic Portal Vein Obstruction by CFD Analysis

GANIT Journal of Bangladesh Mathematical Society ◽

10.3329/ganit.v38i0.39789 ◽

2019 ◽

Vol 38 ◽

pp. 89-104

Author(s):

Mst Khorseda Atkar ◽

Md Tajul Islam

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Control Volume ◽

Clinical Signs ◽

Cfd Analysis ◽

Main Portal Vein ◽

Venous Flow ◽

Portal Vein Obstruction ◽

Hepatic Portal Vein ◽

Hepatic Portal

Extra-hepatic portal vein obstruction (EHPVO) is the blockage to the flow of blood in the portal vein before reaches to the liver. EHPVO is the common cause of portal hypertension in children in the most Asian countries. Examination reveals that the presence of block in the main portal vein may be responsible for the shrinkage of vein with manifold pernicious complication. The “shunt” policy is a fruitful source of restoration of the hepatic portal flow. This study shows that a new approach of bypassing (or shunting) to the blocked (thrombosed) region of the portal vein is a significant way of reducing portal hypertension and restoration of blood circulation. We studied EHPVO case through computational fluid dynamics (CFD) analysis by considering partial block formation and side to side shunt scheme inside the main portal vein. The constitutive equation for non-Newtonian fluidand energy equation are solved by control volume technique. Our study reveals that the shunting technique is strongly effective for the reconstitution of portal venous flow to the liver with lower tissue stress and rapid regression of clinical signs of portal hypertension. This new technique may potentially applicable for medication of EHPVO when shunting procedures are indicated. GANIT J. Bangladesh Math. Soc.Vol. 38 (2018) 89-104

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