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Portal obstruction in children. I. Clinical investigation and hemorrhage risk
Insights
Portal vein obstruction in children often causes bleeding. Ultrasonography is effective for diagnosis, while endoscopy helps predict bleeding risk, guiding treatment decisions.
Area of Science:
- Pediatric Gastroenterology
- Vascular Imaging
Background:
- Portal vein obstruction is a significant cause of morbidity in children.
- Common symptoms include splenomegaly and gastrointestinal tract hemorrhage.
Purpose of the Study:
- To evaluate diagnostic and prognostic methods for pediatric portal vein obstruction.
- To determine the utility of ultrasonography, angiography, and endoscopy.
Main Methods:
- Retrospective analysis of 108 children with portal vein obstruction.
- Diagnostic imaging included ultrasonography and angiography.
- Endoscopic evaluation for esophageal varices.
Main Results:
- Ultrasonography diagnosed obstruction accurately in most cases.
- Angiography revealed extent of venous involvement and collateral formation.
- Endoscopy identified esophageal varices in 79/81 children, with tense varices correlating with bleeding risk.
Conclusions:
- Ultrasonography is a reliable initial diagnostic tool.
- Endoscopy is crucial for assessing bleeding risk and guiding prognosis.
- Angiography is recommended for surgical shunt consideration in high-risk patients.
Abstract:
We examined 108 children with obstruction of the portal vein. Symptoms included splenomegaly and gastrointestinal tract hemorrhage. Obstruction was secondary to portal vein injury in 44 children and was combined with congenital malformations in 17 others. Ultrasonography provided the correct diagnosis in 36 of the 37 children in whom it was performed. Angiography, performed in 101 children, showed that the obstruction extended to the superior mesenteric vein in 14 children and to the entire portal venous system in seven; intrahepatic branches were involved in half the cases. Natural splenorenal shunts were visible in 19 children but were not clearly associated with a lower risk of gastrointestinal tract bleeding; in five of 30 children, cavography displayed abnormalities of the inferior vena cava. Spontaneous gastrointestinal tract hemorrhage occurred in 78 children. Fiberoptic endoscopy showed esophageal varices in 79 of the 81 children studied. The presence of tense varices and congestion of esophageal mucosa clearly augmented the risk of bleeding. These results suggest a simple method of investigation based on ultrasonography for diagnosis and on endoscopy for prognosis. Angiography should be limited to children with a history of gastrointestinal tract bleeding for whom a surgical portosystemic shunt is being considered.