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Gallbladder varices: diagnosis in children with portal hypertension on duplex sonography
P M Rathi1, A Soni, S A Nanivadekar
1Department of Gastroenterology, L.T. Municipal Medical College, Bombay, India.
Insights
Gallbladder varices (GBVs) are common in children with portal hypertension, especially those with extrahepatic portovenous obstruction (EHPVO). Awareness of GBVs is crucial for surgeons due to their bleeding risk during biliary procedures.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatology
Background:
- Portal hypertension in children can lead to various complications.
- Gallbladder varices (GBVs) are a less commonly recognized manifestation.
- Understanding the prevalence and risk factors for GBVs is important for clinical management.
Purpose of the Study:
- To determine the prevalence of gallbladder varices (GBVs) in children with portal hypertension using duplex sonography.
- To investigate the correlation of GBVs with different causes of portal hypertension and clinical factors.
Main Methods:
- A cohort of 55 children with portal hypertension underwent blinded duplex sonography.
- Children were categorized into extrahepatic portovenous obstruction (EHPVO), cirrhosis, and noncirrhotic portal hypertension groups.
- Sonographic findings of GBVs were recorded and analyzed.
Main Results:
- Gallbladder varices (GBVs) were identified in 25% of children with EHPVO and 16.6% of those with cirrhosis.
- No GBVs were observed in children with noncirrhotic portal hypertension.
- In EHPVO patients, GBVs did not correlate with esophageal varices, sclerotherapy, gastric varices, portal gastropathy, or splenorenal shunt.
- In cirrhotic patients, GBVs did not correlate with Child Pugh grade.
Conclusions:
- Children with extrahepatic portovenous obstruction (EHPVO) exhibit a higher incidence of gallbladder varices (GBVs).
- Gallbladder varices (GBVs) pose a bleeding risk during biliary surgery, necessitating surgeon awareness.
- Duplex sonography is effective in identifying GBVs in pediatric patients with portal hypertension.
Abstract:
We established the prevalence of gallbladder varices (GBVs) as seen on duplex sonogram of children with portal hypertension. Fifty-five consecutive children with portal hypertension underwent duplex sonographic examination by an experienced sonologist who was blinded to clinical presentation. Forty children had extrahepatic portovenous obstruction (EHPVO), 12 had cirrhosis, and three had noncirrhotic portal hypertension. GBVs were seen on sonography in 10 of 40 children with EHPVO (25%), two of 12 children with cirrhosis (16.6%), and no children with noncirrhotic portal hypertension. Sonographic findings of GBVs were confirmed on duplex sonographic imaging. Among patients with EHPVO, GBVs did not correlate with size of esophageal varices, number of sessions of sclerotherapy, presence or absence of gastric varices, portal gastropathy, or splenorenal shunt placement. In cirrhotic patients, GBVs did not correlate with Child Pugh grade. Children with EHPVO have a higher incidence of developing GBVs. The clinical significance of GBVs is their propensity to bleed during biliary surgery; thus, the operating surgeon should be made aware of them.