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Transjugular intrahepatic portosystemic shunt performed in a 2-year-old infant with uncontrollable intestinal
1Department of Pediatric Surgery, Osaka University Medical School, Suita City, Japan.
Insights
Transjugular intrahepatic portosystemic shunt (TIPS) successfully controlled severe intestinal bleeding in a pediatric patient with biliary atresia. This interventional radiology procedure offers a potential solution for intractable gastrointestinal hemorrhage in infants.
Area of Science:
- Interventional Radiology
- Pediatric Gastroenterology
- Hepatology
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment for portal hypertension in adults.
- Its application and efficacy in infants remain limited, with few reported successful cases.
Observation:
- A 2-year-old boy with biliary atresia experienced uncontrollable lower intestinal bleeding (melena) despite conservative management and devascularization.
- A transjugular intrahepatic portosystemic shunt (TIPS) was successfully created using a 6 x 50-mm Wallstent, connecting the right hepatic vein to the right portal vein.
Findings:
- Following the TIPS procedure, the portosystemic pressure gradient decreased from 15 to 11 mm Hg.
- Significant reduction in portosystemic collaterals was observed.
- The patient achieved hemostasis and remained free of recurrent bleeding for over 7 months post-procedure.
Implications:
- Transjugular intrahepatic portosystemic shunt (TIPS) demonstrates technical feasibility and effectiveness in managing severe intestinal bleeding in infants.
- Further research and long-term follow-up are necessary to establish TIPS as a reliable treatment option for pediatric portal hypertension complications.
Abstract:
Although transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted in adults, there have been few successful reports in infants. The authors describe a 2-year-old boy with postoperative biliary atresia who underwent TIPS for uncontrollable lower intestinal bleeding and achieved hemostasis. Massive melena developed, which was not controlled by conservative therapy and devascularization. A shunt was created between the right hepatic vein and the right portal vein with a 6- x 50-mm Wallstent. After TIPS, the porto-systemic pressure gradient decreased from 15 to 11 mm Hg, and collaterals markedly reduced. He has not had recurrent bleeding for over 7 months. TIPS may be a technically feasible and effective treatment to control intestinal bleeding in infants. However, further experience and long-term follow-up will be required.