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[Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension].
Cir Pediatr. 2002 Jul; 15(3):114-7.CP

Abstract

Presinusoidal portal hypertension (PPH) in children evaluates without functional hepatic damage, and with the time, trends to compensate through the creation of spontaneous portosystemic shunts. Nevertheless, some patients suffer episodes of gastrointestinal bleeding (GIB) that because of its frequency or severity, force to propose the change of surgical treatment.

AIM

To evaluate the results of the mesocaval shunt (MCS) with autologous jugular vein in children with PPH.

MATERIAL AND METHODS

Among the 32 children with PPH treated in our Hospital in the last 7 years, 10 had episodes of GIB that forced to perform a surgical shunt. The types of shunt were distal splenorenal in 3 patients and mesocaval in 7. These 7 cases are the material of this study. The origin of the PPH was a cavernomatosis transformation of the portal vein in 6 cases and a congenital hepatic fibrosis in 1. Before the surgery the average number of episodes of GIB was 9 (range 2-15); all the patients needed transfusion of blood products and variceal sclerosis. In 2 cases a tamponade with the Sengtaken balloon was required and 5 patients were treated with somatostatin and propranolol. The Doppler ultrasounds revealed and intense hepatofugal collateral circulation in all the cases.

RESULTS

The initial flow through the shunt was adequate in all the patients except one who required a percutaneous balloon dilatation. Only this patient has suffered an episode of GIB. The hyperesplenism signs disappeared or improved in all the seven cases and the collateral circulation was significantly reduced. The pressure in the splenic territory decreased around 50% in the 4 patients that was measured. There were no cases of encephalopasty and only one child with congenital hepatic fibrosis shows signs of mild hepatic disfunction. The medium follow up post-shunt is 32 months (range 8 m-6 years).

CONCLUSIONS

The MCS prevents the GIB in the PPH not responsive to the conservative treatment; its effectiveness is related with an adequate permeability though the graft and at least in the cases with portal cavernomatosis (the most frequent in children) doesn't produce hepatic dysfunction. Doppler ultrasounds give a very precise information about the post-surgical situation and are an excellent method of follow up.

Authors+Show Affiliations

Leal N
Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Paseo de la Castellana, 261, 28046 Madrid.
López Santamaría M
No affiliation info available
Gámez M
No affiliation info available
Murcia J
No affiliation info available
Andolfi G
No affiliation info available
Berrocal T
No affiliation info available
Frauca E
No affiliation info available
Jara P
No affiliation info available
Tovar J
No affiliation info available

MeSH

ChildChild, PreschoolFemaleFollow-Up StudiesHumansHypertension, PortalInfantJugular VeinsMaleMesenteric ArteriesPortasystemic Shunt, SurgicalSeverity of Illness IndexVenae Cavae

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

12601985

Citation

Leal, N, et al. "[Mesenteric-cava Shunt's Results With Autologous Jugular Vein Graft in Children With Pre-sinusoidal Portal Hypertension]." Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica, vol. 15, no. 3, 2002, pp. 114-7.
Leal N, López Santamaría M, Gámez M, et al. [Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension]. Cir Pediatr. 2002;15(3):114-7.
Leal, N., López Santamaría, M., Gámez, M., Murcia, J., Andolfi, G., Berrocal, T., Frauca, E., Jara, P., & Tovar, J. (2002). [Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension]. Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica, 15(3), 114-7.
Leal N, et al. [Mesenteric-cava Shunt's Results With Autologous Jugular Vein Graft in Children With Pre-sinusoidal Portal Hypertension]. Cir Pediatr. 2002;15(3):114-7. PubMed PMID: 12601985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension]. AU - Leal,N, AU - López Santamaría,M, AU - Gámez,M, AU - Murcia,J, AU - Andolfi,G, AU - Berrocal,T, AU - Frauca,E, AU - Jara,P, AU - Tovar,J, PY - 2003/2/27/pubmed PY - 2003/4/23/medline PY - 2003/2/27/entrez SP - 114 EP - 7 JF - Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica JO - Cir Pediatr VL - 15 IS - 3 N2 - UNLABELLED: Presinusoidal portal hypertension (PPH) in children evaluates without functional hepatic damage, and with the time, trends to compensate through the creation of spontaneous portosystemic shunts. Nevertheless, some patients suffer episodes of gastrointestinal bleeding (GIB) that because of its frequency or severity, force to propose the change of surgical treatment. AIM: To evaluate the results of the mesocaval shunt (MCS) with autologous jugular vein in children with PPH. MATERIAL AND METHODS: Among the 32 children with PPH treated in our Hospital in the last 7 years, 10 had episodes of GIB that forced to perform a surgical shunt. The types of shunt were distal splenorenal in 3 patients and mesocaval in 7. These 7 cases are the material of this study. The origin of the PPH was a cavernomatosis transformation of the portal vein in 6 cases and a congenital hepatic fibrosis in 1. Before the surgery the average number of episodes of GIB was 9 (range 2-15); all the patients needed transfusion of blood products and variceal sclerosis. In 2 cases a tamponade with the Sengtaken balloon was required and 5 patients were treated with somatostatin and propranolol. The Doppler ultrasounds revealed and intense hepatofugal collateral circulation in all the cases. RESULTS: The initial flow through the shunt was adequate in all the patients except one who required a percutaneous balloon dilatation. Only this patient has suffered an episode of GIB. The hyperesplenism signs disappeared or improved in all the seven cases and the collateral circulation was significantly reduced. The pressure in the splenic territory decreased around 50% in the 4 patients that was measured. There were no cases of encephalopasty and only one child with congenital hepatic fibrosis shows signs of mild hepatic disfunction. The medium follow up post-shunt is 32 months (range 8 m-6 years). CONCLUSIONS: The MCS prevents the GIB in the PPH not responsive to the conservative treatment; its effectiveness is related with an adequate permeability though the graft and at least in the cases with portal cavernomatosis (the most frequent in children) doesn't produce hepatic dysfunction. Doppler ultrasounds give a very precise information about the post-surgical situation and are an excellent method of follow up. SN - 0214-1221 UR - https://www.unboundmedicine.com/medline/citation/12601985/[Mesenteric_cava_shunt's_results_with_autologous_jugular_vein_graft_in_children_with_pre_sinusoidal_portal_hypertension]_ DB - PRIME DP - Unbound Medicine ER -