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Extrahepatic portal vein thrombosis after umbilical catheterization: is it a good choice for Rex shunt?

Nelson Elias Mendes Gibelli1, Ana Cristina Aoun Tannuri, Maria Lúcia Pinho-Apezzato

  • 1Instituto da Criança, Hospital das Clínicas, Pediatric Surgery and Liver Transplantation Division, Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil. nelson.gibelli@icr.usp.br

Journal of Pediatric Surgery
|January 18, 2011
PubMed

Insights

The Rex shunt is effective for treating pediatric extrahepatic portal vein thrombosis (EHPVT) causing portal hypertension, especially in idiopathic cases. Its role in post-catheterization EHPVT requires further evaluation.

Area of Science:

  • Pediatric surgery
  • Hepatology
  • Vascular surgery

Background:

  • Extrahepatic portal vein thrombosis (EHPVT) is a significant cause of portal hypertension in children.
  • The Rex shunt procedure has shown success in managing these pediatric patients.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the Rex shunt in pediatric patients with EHPVT.
  • To assess the suitability of the Rex shunt for different etiologies of EHPVT.

Main Methods:

  • A retrospective review of 19 infants and children (5 months to 14 years) with EHPVT who underwent a mesenteric-portal surgical shunt using a left internal jugular vein autograft.
  • Patients were categorized by EHPVT etiology: idiopathic, post-umbilical catheterization, portal vein agenesis, and post-transplant.

Main Results:

  • Rex shunt creation was successful in most cases, except for 8 out of 9 patients with post-umbilical catheterization EHPVT, where alternative shunts (Warren procedure, proximal splenorenal shunt) were performed.
  • One instance of shunt thrombosis occurred in a patient with portal vein agenesis and a cardiac anomaly.
  • Significant improvement in portal hypertension was observed post-surgery, with no new gastrointestinal bleeding episodes reported during the 3-26 month follow-up.

Conclusions:

  • The Rex shunt is a recommended treatment for children with idiopathic EHPVT and refractory gastrointestinal bleeding.
  • The effectiveness of the Rex shunt for EHPVT secondary to umbilical catheterization needs further investigation.
Abstract

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