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[Early gastro-intestinal bleeding in children with portal hypertension (author's transl)]
Insights
Early surgical portosystemic shunt is a viable solution for gastrointestinal bleeding in children with portal hypertension. This intervention offers a permanent fix for life-threatening bleeding episodes in young patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Interventions
Context:
- Portal hypertension in children under 3 years old often leads to severe gastrointestinal bleeding.
- Common causes include extrahepatic portal vein obstruction, cirrhosis, and congenital hepatic fibrosis.
- Endoscopic findings confirm significant portal hypertension in most affected children.
Purpose:
- To evaluate the effectiveness of surgical interventions for portal hypertension and gastrointestinal bleeding in young children.
- To compare outcomes of direct esophageal variceal ligation versus surgical portosystemic shunts.
Summary:
- A retrospective study of 47 children identified extrahepatic portal obstruction as the primary cause of portal hypertension.
- Surgical portosystemic shunt surgery in 37 children demonstrated success in 7 out of 11 cases, with 32 showing shunt patency.
- Direct ligation of esophageal varices in 8 children had limited success, with most experiencing re-bleeding within a year.
Impact:
- Early surgical shunt procedures can offer a permanent solution to life-threatening gastrointestinal bleeding in pediatric patients.
- Results suggest that timely surgical intervention is crucial for managing severe bleeding complications associated with portal hypertension.
Abstract:
From the retrospective study of 47 children who presented with portal hypertension and gastro-intestinal bleeding before 3 years of age, the following conclusions can be drawn: 1) The cause of portal hypertension was extrahepatic portal obstruction in 35 children, cirrhosis in 10 and congenital hepatic fibrosis in 2. 2) Endoscopic signs of major portal hypertension were present in 26 of 27 children in whom a thorough endoscopic examination was carried out. 3) Most children experienced several episodes of bleeding. One or several hematemeses occurred in 36 children, one or several episodes of melaena in 23, one or several proctorrhagia in 5 and anemia alone in 2. Two children with liver failure died during a gastrointestinal bleeding episode. 4) Transthoracic direct ligation of esophageal varices was performed in 8 children ; all but one experienced one or more episodes of bleeding within one year after surgery. One child died during one of these episodes. 5) A surgical portosystemic shunt was carried out in 37 rated on before the age of 3. Shunts were successful in 7 of 11 children who were ope children. Patency of the shunt was demonstrated in 32. These results show that early shunt surgery can provide a permanent solution to the life-threatening problems of gastrointestinal bleeding in young children with portal hypertensions.