Related Experiment Video

Updated: Aug 5, 2026

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
09:37

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

Published on: August 1, 2018

The aetiology, presentation and natural history of extra-hepatic portal venous obstruction

L J Webb, S Sherlock

    The Quarterly Journal of Medicine
    |October 1, 1979
    PubMed

    Insights

    Extra-hepatic portal vein obstruction frequently causes hypertension in children and adults. While surgery may control severe bleeding, conservative management is often preferred due to higher mortality rates in surgical cases.

    Area of Science:

    • Gastroenterology
    • Pediatric Gastroenterology
    • Vascular Surgery

    Background:

    • Extra-hepatic portal vein obstruction (EHPVO) is a significant cause of portal hypertension, particularly in childhood.
    • While often presenting in pediatric patients, a notable proportion of cases manifest in adulthood.

    Purpose of the Study:

    • To analyze the clinical presentation, outcomes, and management strategies for extra-hepatic portal vein obstruction.
    • To compare the efficacy and mortality associated with surgical versus conservative management of variceal bleeding in EHPVO patients.

    Main Methods:

    • Retrospective analysis of 97 patients diagnosed with extra-hepatic portal vein obstruction.
    • Review of patient demographics, clinical presentation (hematemesis, splenomegaly, ascites), precipitating factors, and treatment outcomes.

    Main Results:

    • 57% of patients presented before age 15, but 43% presented in adulthood. Hematemesis was the most common symptom in both groups.
    • Ascites was more prevalent in adults (69%) and associated with increased mortality (p<0.01). Portal-systemic encephalopathy affected 45% of ascites patients.
    • Variceal hemorrhage caused 19 deaths; infection caused 5 deaths. Surgical intervention for bleeding had a higher mortality rate than conservative management.

    Conclusions:

    • Extra-hepatic portal vein obstruction requires careful management, with a significant number of cases presenting in adulthood.
    • Conservative management is generally associated with better outcomes than surgical intervention for variceal bleeding in EHPVO.
    • Surgery should be reserved for refractory cases where bleeding cannot be controlled by medical means.

    More Related Videos

    Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension04:00

    Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

    Published on: November 15, 2024

    New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation08:45

    New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation

    Published on: June 27, 2025

    Related Concept Videos

    Barrett Esophagus-II: Clinical Manifestations and Management01:21

    Barrett Esophagus-II: Clinical Manifestations and Management

    Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
    To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
    Esophageal Varices-I: Introduction01:24

    Esophageal Varices-I: Introduction

    Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
    Esophageal Varices-II: Clinical Features and Management01:28

    Esophageal Varices-II: Clinical Features and Management

    Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
    In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
    Varicose Veins I: Introduction01:26

    Varicose Veins I: Introduction

    Varicose veins, or varicosities, are abnormally dilated and twisted superficial veins caused by venous valve incompetence. This condition commonly affects the lower extremities, especially the saphenous veins, due to the higher pressure from prolonged standing and walking. However, varicosities can also occur in other areas, such as the esophagus, vulva, spermatic cords, and anorectal region.Etiology and typesPrimary varicose veins, often idiopathic, are more common in women due to inherent...
    Cirrhosis II: Pathophysiology01:24

    Cirrhosis II: Pathophysiology

    Cirrhosis is a progressive chronic liver injury caused by prolonged inflammation, excessive fibrotic remodeling, and impaired regeneration. Over time, repeated hepatic insults disrupt the liver’s architecture and function, leading to reduced blood flow, impaired bile drainage, and diminished metabolic capacity.Pathophysiology of cirrhosisCirrhosis arises from three main responses to chronic liver damage: inflammation, immune activation, and hepatocyte death. These processes lead to structural...
    Portal Hypertension01:22

    Portal Hypertension

    Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...