Mesenteric to left portal vein bypass in pediatrics with extrahepatic portal vein obstruction
DOI:
https://doi.org/10.24054/cbs.v2i2.2852Keywords:
Umbilical Veins, Portal Vein, Hypertension, Portal, Hypersplenism, Esophageal and Gastric Varices, Portasystemic Shunt, SurgicalAbstract
Background: Obstruction of the extrahepatic portal vein can occur with or without intrahepatic involvement, it is characterized by findings of recent thrombosis or Portal cavernomatosis. Aim: Evidence clinical manifestations, laboratory, and endoscopic changes of mesoportal shunt in children with obstruction of the extra hepatic portal vein. Material and methods. Retrospective case series, five patients with extra hepatic portal vein obstruction were included, the inclusion criteria were recurrent bleeding, endoscopic treatment failure and severe hypersplenism, children were excluded who could not perform this technique by compromise parenchyma in liver biopsy or vascular anatomical abnormalities. The study was conducted in a third level hospital in Mexico, the data were obtained from the clinical records. Statistical analysis was performed through the SPSS program version 23.0 at values with p < 0.05 were statistically significant. Results: Five patients are described, in the 100% with a history of prematurity, umbilical catheterization in newborn. In 100% esophageal, gastric varices and upper gastrointestinal bleeding prior to shunt, leukopenia, and lymphopenia 80%, thrombocytopenia and hypersplenism 100%, prolonged prothrombin time 60%, ascites 20% were identified. There were no complications during the intervention or after surgery, the permeability of the shunt was evaluated by postoperative Doppler ultrasound and abdominal CT. Conclusion: Mesoportal Shunt establishes a curative approach restoring hepatic blood flow. This surgical technique has demonstrated significant clinical improvement of portal hypertension including bleeding from variceal etiology, hypersplenism and impact on nutritional status.
References
De Franchis R. Portal hypertension VI. Proceedings of the Sixth Baveno Consensus Workshop: Stratifying Risk and Individualizing Care. 1th.ed. Switzerland: Springer; 2016. 424p. Available from: https://doi.org/10.1007/978-3-319-23018-4_5.
Manzano MC, Barranco B, Uribe M. Portal vein thrombosis: what is new? Ann Hepatol. 2015;14(1): 20-27. Available from: https://doi.org/10.1016/S1665-2681(19)30797-5.
Siramolpiwat S, Seijo S, Miquel R, Berzigotti A, Garcia A, Darnell A, et al. Idiopathic portal hypertension: natural history and long-term outcome. Hepatology. 2014; 59(6): 2276-85. Available from: https://doi.org/10.1002/hep.26904.
Shneider BL, de Ville de Goyet J, Leung DH, Srivastava A, Ling SC, Duché M, et al. Primary prophylaxis of variceal bleeding in children and the role of Meso-Rex bypass: summary of the Baveno VI pediatric satellite symposium. Hepatology. 2016;63(4):1368-80. Available from: https://doi.org/10.1002/hep.28153.
Duché M, Ducot B, Ackermann O, Guerin F, Jacquemin E, Bernard O. Portal hypertension in children: high-risk varices, primary prophylaxis, and consequences of bleeding. J Hepatol. 2017;66(2):320-27. Available from: https://doi.org/10.1016/j.jhep.2016.09.006.
Franchi S, Fabre M, Mselati E, De Marsillac ME, Bayari M, et al. Obliterative portal venopathy: a study of 48 children. J Pediatr. 2014;165:190-93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24768253.
El-Karaksy HM, El-Koofy N, Mohsen N, Helmy H, Nabil N, El-Shabrawi M. Extrahepatic portal vein obstruction in Egyptian children. JPGN. 2015;60(1):105-109. Available from: http://dx.doi.org/10.1097/MPG.0000000000000548.
Seijo S, Lozano J, Alonso C, Miquel R, Berzigotti A, Reverter E, et al. Metabolomics as a diagnostic tool for idiopathic noncirrhotic portal hypertension. Liver Int. 2016;36(7):1051-58. Available from: https://doi.org/10.1111/liv.12972.
Ferreira N, Seijo S, Plessier A, Silva G, Turon F, Rautou PE, et al. Natural history and management of esophagogastric varices in chronic noncirrhotic, nontumoral portal vein thrombosis. Hepatology. 2016;63(5):1640-50. Available from: https://doi.org/10.1002/hep.28466.
Khanna R, Sarin SK. Non-cirrhotic portal hypertension. J Hepatol. 2014;60(2):421-41. Available from: https://doi.org/10.1016/j.jhep.2013.08.013.
McKiernan P, Abdel M. Advances in the management of childhood portal hypertension. Expert Rev Gastroenterol Hepatol. 2015;9(5):575-83. Available from: https://doi.org/10.1586/17474124.2015.993610.
Bissonnette J, Garcia JC, Albillos A, Turon F, Ferreira C, Tellez L, et al. Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension. Hepatology. 2016;64(1):224-31. Available from: https://doi.org/10.1002/hep.28547.
Zhang JS, Li L, Cheng W. A new procedure for the treatment of extrahepatic portal hypertension in children: portal cavernoma-Rex shunt with interposition of grafted portal vessel. J Am Coll Surg. 2016;222(6):71-76. Available from: https://doi.org/10.1016/j.jamcollsurg.2016.03.020.
Jeanniard O, Duché M, Fabre A. Survey on clinical practice of primary prophylaxis in portal hypertension in children. JPGN. 2017;64(4):524–527. Available from: https://doi.org/10.1097/MPG.0000000000001453
Suchy FJ, Sokol RJ, Balistreri WF, editors. Liver disease in children. Fourth edition. New York: Cambridge University Press; 2014. 828p. ISBN 978-1-107-01379-7.
Oh SH, Kim SJ, Rhee KW, Kim KM. Endoscopic cyanoacrylate injection for the treatment of gastric varices in children. World J Gastroenterol. 2015;21(9):2719-24. Available from: https://doi.org/10.3748/wjg.v21.i9.2719.
Sood V, Lal BB, Khanna R, Rawat D, Bihari C, Alam S. Noncirrhotic portal fibrosis in pediatric population. JPGN. 2017;64(5):748–753. Available from: https://doi.org/10.1097/MPG.0000000000001485
Rockey DC. A New treatment for Portal hypertension? Gastroenterology. 2016;150(5):1077–80. Available from: https://doi.org/10.1053/j.gastro.2016.03.015.
Lal R, Sarma MS, Gupta MK. Extrahepatic Portal Venous Obstruction: What Should be the Mainstay of Treatment? Indian J Pediatr. 2017;84(9):691-99. Available from: https://doi.org/10.1007/s12098-017-2390-5.
Rajeev Khanna, R. Shiv, S. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatology International. 2018; (12 Suppl 1): S148-167. Available from: https://doi.org/10.1007/s12072-018-9844-3.
Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol. 2015;5(1):22-40. Available from: https://doi.org/10.1016/j.jceh.2014.12.008.
Grammatikopoulos T, McKiernan, P. Dhawan, A. Portal hypertension and its management in children. Archives of Disease in Childhood. 2017;103(2):186-91. Available from: https://doi.org/10.1136/archdischild-2015-310022.
Lautz TB, Eaton S, Keys L, Ito J, Polo M, Wells JCK. Metabolic profile of children with extrahepatic portal vein obstruction undergoing meso-Rex bypass. J Surg Res. 2018;223:109-114. Available from: https://doi.org/10.1016/j.jss.2017.10.010.
Mouzaki M, Bronsky J, Gupte G, Hojsak, I Jahnel, J Pai, N et col. Nutrition Support of Children with Chronic Liver Diseases. JPGN. 2019;69(4):498-511. Available from: https://doi.org/10.1097/MPG.0000000000002443.
Hurtado EF, Vasquez EM, Trujillo X, et al. Body composition predicts growth in infants and toddlers with chronic liver disease. JPGN. 2017;65(6):117-119. Available from: https://doi.org/10.1097/MPG.0000000000001746.
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