Imaging and radiological interventions in extra-hepatic portal vein obstruction

Area of Science:

• Vascular Surgery
• Pediatric Gastroenterology
• Interventional Radiology

Background:

• Extrahepatic portal vein obstruction (EHPVO) is a chronic blockage of the portal vein, a leading cause of pediatric portal hypertension, particularly in developing nations.
• EHPVO is a pre-hepatic condition preserving liver function and morphology until late stages.
• It often manifests in childhood with recurrent variceal bleeding and characteristic imaging findings like parabiliary collaterals and portal biliopathy.

Purpose of the Study:

• To provide a comprehensive overview of Extrahepatic portal vein obstruction (EHPVO).
• To highlight diagnostic imaging modalities for EHPVO and its complications.
• To discuss the role of interventional radiology in managing EHPVO.

Main Methods:

• Non-invasive imaging techniques including Ultrasound with Doppler, CT, MRCP, and MR Portography are crucial for diagnosis.
• These methods assess the extent of EHPVO, collateral formation, and biliary abnormalities.
• Imaging aids in surgical planning and postoperative shunt surveillance.

Main Results:

• EHPVO leads to significant vascular and biliary changes, including portal biliopathy or portal cavernoma cholangiopathy.
• Imaging accurately characterizes the obstruction, collaterals, and bile duct abnormalities.
• Radiological interventions offer effective management for diverse EHPVO complications.

Conclusions:

• Extrahepatic portal vein obstruction (EHPVO) is a significant cause of pediatric portal hypertension requiring multidisciplinary management.
• Advanced imaging techniques are essential for comprehensive diagnosis and treatment planning.
• Interventional radiology provides a range of procedures to manage the complex vascular and biliary complications of EHPVO.