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Extrahepatic portal hypertension: a review of 70 cases
Insights
Extrahepatic portal hypertension in children frequently causes bleeding. Surgical shunts like splenorenal anastomosis can prevent further bleeding, though operative mortality is a concern.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Interventions
Background:
- Extrahepatic portal hypertension (EHPH) is a significant cause of gastrointestinal bleeding in children.
- Over 350 bleeding episodes were documented in 70 children with EHPH.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions for extrahepatic portal hypertension in pediatric patients.
- To assess the efficacy of specific surgical shunts in preventing recurrent bleeding.
Main Methods:
- Retrospective analysis of 70 children diagnosed with extrahepatic portal hypertension.
- Comparison of outcomes between a non-operated group (32 children) and an operated group (38 children).
- Evaluation of central splenorenal and cavomesenteric anastomosis procedures.
Main Results:
- Six deaths (19%) occurred due to bleeding in the non-operated group.
- Twelve children in the non-operated group are well, with some experiencing rebleeding.
- Surgical shunts prevented further bleeding in 10 of 12 evaluated cases.
- Operative mortality was 24%, primarily in emergency procedures.
Conclusions:
- Surgical management, particularly with specific anastomosis procedures, offers a viable option for controlling bleeding in pediatric EHPH.
- While effective, surgical interventions carry significant operative risks, especially in emergency settings.
Abstract:
Among 70 children with extrahepatic portal hypertension, more than 350 episodes of bleeding occurred. Of the 32 children who were not operated upon, six (19%) died of bleeding. Twelve children in the nonoperated group are thriving and well, although six of them have rebled 1-2 times. The operated group of 38 children had a total of 43 procedures. Central splenorenal and cavomesenteric anastomosis prevented further bleeding in 10 of 12 cases in which follow-up is available. Operative mortality was 24%, the majority of which were in emergency procedures.