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Portal hypertension in children. An experience of 33 cases

A I Macpherson

    Scottish Medical Journal
    |January 1, 1984
    PubMed

    Insights

    This study reviews 33 children with portal hypertension, finding good prognoses for extra-hepatic portal obstruction (EHB) and variable outcomes for intra-hepatic obstruction (IHB) based on hepatic severity and surgical approach. Surgical intervention is key for managing this condition.

    Area of Science:

    • Pediatric Gastroenterology
    • Hepatology
    • Surgical Interventions

    Background:

    • Portal hypertension in children presents diverse etiologies, including extra-hepatic portal obstruction (EHB) and intra-hepatic obstruction (IHB).
    • Understanding the specific causes, such as portal vein blockages in EHB and post-hepatitis cirrhosis or congenital abnormalities in IHB, is crucial for effective management.
    • Long-term outcomes and treatment efficacy necessitate detailed review.

    Purpose of the Study:

    • To review the pathology, treatment, and long-term progress of pediatric patients diagnosed with portal hypertension.
    • To compare the outcomes and prognoses between children with extra-hepatic portal obstruction (EHB) and intra-hepatic obstruction (IHB).
    • To evaluate the impact of different surgical procedures on survival rates and recurrent bleeding in children with portal hypertension.

    Main Methods:

    • Retrospective review of 33 pediatric patients with portal hypertension.
    • Classification of patients into extra-hepatic portal obstruction (EHB) and intra-hepatic obstruction (IHB) groups based on lesion location.
    • Analysis of surgical treatments, patient survival, and incidence of recurrent bleeding following various operative procedures.

    Main Results:

    • Out of 33 children, 20 had EHB (portal vein block) and 13 had IHB (post-hepatitis cirrhosis or congenital abnormality).
    • Surgical treatment was performed in 32 patients, with a generally good prognosis and long survival observed in the EHB group.
    • In the IHB group, survival was contingent on hepatic disorder severity, with lieno-renal anastomosis showing the lowest incidence of recurrent bleeding compared to splenectomy alone or with devascularisation.

    Conclusions:

    • Extra-hepatic portal obstruction (EHB) in children generally carries a favorable prognosis with surgical intervention.
    • Outcomes for intra-hepatic obstruction (IHB) are significantly influenced by the underlying hepatic condition and the chosen surgical approach.
    • The selection of surgical procedure, particularly lieno-renal anastomosis, plays a critical role in minimizing recurrent bleeding and improving long-term survival in pediatric portal hypertension.

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