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[Porto-systemic shunts in children: Schneider Children's Medical Center experience].
Harefuah. 2002 Nov; 141(11):953-6, 1011.H

Abstract

Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem.

AIMS

We present our experience with the porto-systemic shunt for extrahepatic portal hypertension.

PATIENTS AND METHODS

Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension.

RESULTS

During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly.

CONCLUSIONS

We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism.

Authors+Show Affiliations

Mor E
Department of Transplantation, Schneider Children's Medical Center, Petah Tikva.
Bar-Nathan N
No affiliation info available
Shapira R
No affiliation info available
Katchko M
No affiliation info available
Dinari G
No affiliation info available

MeSH

AdolescentChildChild, PreschoolFemaleFollow-Up StudiesHumansHypertension, PortalInfantMalePortasystemic Shunt, SurgicalRetrospective StudiesTime Factors

Pub Type(s)

English Abstract
Journal Article

Language

heb

PubMed ID

12476627

Citation

Mor, Eytan, et al. "[Porto-systemic Shunts in Children: Schneider Children's Medical Center Experience]." Harefuah, vol. 141, no. 11, 2002, pp. 953-6, 1011.
Mor E, Bar-Nathan N, Shapira R, et al. [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. Harefuah. 2002;141(11):953-6, 1011.
Mor, E., Bar-Nathan, N., Shapira, R., Katchko, M., & Dinari, G. (2002). [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. Harefuah, 141(11), 953-6, 1011.
Mor E, et al. [Porto-systemic Shunts in Children: Schneider Children's Medical Center Experience]. Harefuah. 2002;141(11):953-6, 1011. PubMed PMID: 12476627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. AU - Mor,Eytan, AU - Bar-Nathan,Nati, AU - Shapira,Riki, AU - Katchko,Mila, AU - Dinari,Gabriel, PY - 2002/12/13/pubmed PY - 2003/1/1/medline PY - 2002/12/13/entrez SP - 953-6, 1011 JF - Harefuah JO - Harefuah VL - 141 IS - 11 N2 - UNLABELLED: Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem. AIMS: We present our experience with the porto-systemic shunt for extrahepatic portal hypertension. PATIENTS AND METHODS: Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension. RESULTS: During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly. CONCLUSIONS: We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism. SN - 0017-7768 UR - https://www.unboundmedicine.com/medline/citation/12476627/[Porto_systemic_shunts_in_children:_Schneider_Children's_Medical_Center_experience]_ DB - PRIME DP - Unbound Medicine ER -