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Vincenzo Carollo, Gianluca Marrone, Kelvin Cortis, Giuseppe Mamone, Settimo Caruso, Mariapina Milazzo, Luigi Maruzzelli, Fabrizio di Francesco, Martin Delle, Roberto Miraglia, Jean de Ville de Goyet
Extrahepatic portal vein obstruction (EHPVO) is the most common cause of upper gastrointestinal bleeding in children. It is defined as thrombosis of the extrahepatic portal vein with or without extension to the intrahepatic portal veins. The Meso-Rex shunt is the gold standard treatment in children with favorable anatomy since it restores physiological portal liver reperfusion. This is achieved by rerouting the splanchnic venous blood through an autologous graft from the superior mesenteric vein (SMV) into the Rex recess of the left portal vein, curing portal hypertension by doing so...
November 22, 2018: Abdominal Radiology
Sydne Muratore, Siobhan Flanagan, David Hunter, Robert Acton
PURPOSE: Extrahepatic portal vein obstruction (EHPVO) is the most frequent cause of portal hypertension in children. Some patients are not amenable to meso-Rex bypass and alternative surgeries don't restore physiologic flow. We aim to demonstrate the feasibility and safety of minilaparotomy for recanalization of chronic EHPVO. METHODS: This 2013-2015 single-center, retrospective review included pediatric patients with chronic EHPVO who underwent minilaparotomy, mesenteric vein access, and attempted recanalization of the occluded portal vein...
November 8, 2018: Journal of Pediatric Gastroenterology and Nutrition
Kumble S Madhusudhan, Ragini Kilambi, Shalimar, Sujoy Pal, Raju Sharma, Deep N Srivastava
Background/Aims: To compare splenic stiffness (SS) with intra-operative portal pressures (PPs) in patients of extrahepatic portal vein obstruction (EHPVO). Methods: Twenty-one patients (14 males; 7 females) of mean age 20.4 years with clinical and sonographic diagnosis of EHPVO were included in this approved prospective study. Endoscopy for esophageal varices (EV) was done in all patients followed by ultrasonographic 2D shear wave elastography (SWE) of spleen. Three values were taken at different areas of spleen avoiding major vessels and mean was calculated...
September 2018: Journal of Clinical and Experimental Hepatology
Moinak Sen Sarma, Surender Kumar Yachha, Praveer Rai, Zafar Neyaz, Anshu Srivastava, Ujjal Poddar
BACKGROUND: Portal cavernoma cholangiopathy (PCC), a surgical-endoscopic dilemma, has not been studied comprehensively, more so in children. Our study aimed to evaluate PCC in children using a combination of magnetic resonance cholangiography-portovenography (MRC-MRPV) and endoscopic ultrasonography (EUS). METHODS: In this prospective cross-sectional study, recruited children with extrahepatic portal venous obstruction (EHPVO) underwent MRC-MRPV and radial array EUS...
October 2018: Journal of Hepato-biliary-pancreatic Sciences
Kumble Seetharama Madhusudhan, Ragini Kilambi, Shalimar, Peush Sahni, Raju Sharma, Deep Narayan Srivastava, Arun Kumar Gupta
OBJECTIVE: To assess the accuracy of splenic stiffness (SS) measured by 2D-shear wave elastography (SWE) for predicting variceal bleeding in the patients with extrahepatic portal vein obstruction (EHPVO). METHODS: 52 patients with EHPVO (mean age: 22.29 years; 26 each males and females) were included in the study after obtaining approval from the institute ethics committee. All patients initially underwent upper gastrointestinal endoscopy followed by ultrasonography, including 2D-SWE on the Aixplorer Supersonic Imagine scanner...
December 2018: British Journal of Radiology
Jacob Therakathu, Hirenkumar Kamleshkumar Panwala, Salil Bhargava, Anu Eapen, Shyamkumar Nidugala Keshava, Deepu David
Aim: The aim of our study was to evaluate the computed tomography (CT) imaging features of splenic artery aneurysm and pseudoaneurysm and to identify the disease conditions related to the same. We also wanted to ascertain any relationship between these associated disease conditions and the imaging features of the aneurysms. Materials and Methods: This retrospective study included patients diagnosed to have splenic artery aneurysms on contrast-enhanced CT examination between January 2001 and January 2016...
2018: Journal of Clinical Imaging Science
Paloma Triana Junco, Ana Alvarez, Mariela Dore, Javier Jimenez Gomez, Alba Sánchez Galán, Alejandra Vilanova-Sánchez, Ane Andres, Jose Luis Encinas, Leopoldo Martinez, Francisco Hernandez, Manuel Lopez Santamaria
AIM:  Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. PATIENTS AND METHODS:  Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activity, splenomegaly, and gastrointestinal bleeding 10 years after surgery. RESULTS:  Thirty-three patients were evaluated, mostly males (64%) and presenting with gastrointestinal bleeding (46%)...
August 7, 2018: European Journal of Pediatric Surgery
Ragini Kilambi, Anand Narayan Singh, Kumble Seetharama Madhusudhan, Sujoy Pal, Renu Saxena, Shalimar, Nihar Ranjan Dash, Peush Sahni
BACKGROUND AND AIMS: Portal hypertension (PHT) due to extrahepatic portal venous obstruction (EHPVO) is common in developing countries. Hypersplenism is a near-constant feature of EHPVO, but its significance, unlike in cirrhotics, is unknown. We aimed to study the relationship between hypersplenism and the severity of PHT in patients with EHPVO. METHODS: This prospective study was done at a tertiary care center from January 2014 to August 2015. All patients with EHPVO who underwent a splenectomy and a shunt or devascularization were included...
June 23, 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Jin-Shan Zhang, Long Li, Wei Cheng
PURPOSE: Although Rex shunt is an effective treatment for extrahepatic portal venous obstruction (EHPVO), 4-20% children develop rebleeding postoperatively. This study was used to evaluate the surgical treatment of rebleeding after Rex shunt in our center. METHOD: From June 2008 to Jan 2017, 12 of 122 children with EHPVO underwent a second operation due to graft stenosis and occlusion after Rex shunt in our center. The abdominal ultrasound and computed tomography (CT) showed the occlusion of bypass vein in nine children, stenosis of bypass vein in two children, and the patency of bypass vein in one child with dysplasia of intrahepatic portal vein...
May 2018: Pediatric Surgery International
Rajeev Khanna, Shiv Kumar Sarin
BACKGROUND: Idiopathic portal hypertension (IPH) and extrahepatic portal venous obstruction (EHPVO) are non-cirrhotic vascular causes of portal hypertension (PHT). Variceal bleed and splenomegaly are the commonest presentations. AIM: The present review is intended to provide the existing literature on etiopathogenesis, clinical profile, diagnosis, natural history and management of IPH and EHPVO. RESULTS: IPH and EHPVO are both characterized by normal hepatic venous pressure gradient, moderate to massive splenomegaly with preserved liver synthetic functions...
February 2018: Hepatology International
Timothy B Lautz, Simon Eaton, Lisa Keys, Joy Ito, Mario Polo, Jonathan C K Wells, Agostino Pierro, Riccardo A Superina
BACKGROUND: Extrahepatic portal vein obstruction (EHPVO) in children is often associated with growth restriction, which improves after the restoration of portal venous flow with a meso-Rex bypass, but the physiologic mechanism is unknown. The purpose of this study was to investigate the mechanism of growth delay in children with EHPVO by detailing the metabolic and nutritional profile before and after meso-Rex bypass. METHODS: Twenty consecutive children with EHPVO were prospectively studied before and 1 year after meso-Rex bypass...
March 2018: Journal of Surgical Research
Meera Vyshni Suresh, Barath Jagadisan, Preeti Kandasamy, Gandhipuram Periyasamy Senthilkumar
OBJECTIVES: Minimal hepatic encephalopathy (MHE) has been reported in children with extrahepatic portal vein obstruction (EHPVO). MHE assessment is restricted to research situations as neuropsychiatric tests are time-intensive. Computerized Stroop Test (CST) has been used in cirrhotic adults for MHE screening. The study aims to assess MHE frequency in young Indian children with EHPVO and validate CST for MHE screening in pediatric EHPVO. METHODS: Thirty-seven children with EHPVO between 7 and 12 years of age and 37 age- and sex-matched controls were enrolled...
May 2018: Journal of Pediatric Gastroenterology and Nutrition
Maeva Guillaume, Camille Christol, Aurélie Plessier, Michèle Corbic, Jean-Marie Péron, Agnès Sommet, Pierre-Emmanuel Rautou, Yann Consigny, Jean-Pierre Vinel, Charles-Dominique Valla, Christophe Bureau
BACKGROUND AND OBJECTIVES: Noncirrhotic nontumoral extrahepatic portal vein obstruction (EHPVO) is the second leading cause of portal hypertension (PHT) and is mainly related to prothrombotic disorders. Patients with EHPVO often require prolonged oral anticoagulation therapy (OAT) together with variceal band ligation (VBL) to prevent thrombosis recurrence and PHT-related bleeding, respectively. The benefit-risk balance of VBL in this context remains unknown. We aimed to assess upper gastrointestinal bleeding (UGB) risk and variceal eradication efficacy in EHPVO patients undergoing a VBL program without stopping OAT...
May 2018: European Journal of Gastroenterology & Hepatology
Mayank Jain, Jenisha Jain, Gauri Rao Passi, Kamna Jain, Shikhar Jain
Introduction: There is a paucity of data regarding the clinical profile of children with extrahepatic portal venous obstruction (EHPVO) from Central India. Material and methods: Retrospective analysis of 30 children with EHPVO treated between 2002 and 2012. Results: The median age of presentation was 12.5 years (range 5-14 years) and median duration of symptoms was 3.2 years (range 0.3-10 years). Home delivery was noted in 30 cases (100%), umbilical sepsis in 8 (27%) and history of cow dung application over the umbilical cord in 2 cases (6...
December 2017: Clinical and Experimental Hepatology
Akash Shukla, Amit Gupte, Vedant Karvir, Prashant Dhore, Shobna Bhatia
Aims: The natural history of portal cavernoma cholangiopathy (PCC) in patients with significant biliary obstruction (SBO) who cannot undergo shunt surgery, is not known. We therefore, analyzed data of patients of extra-hepatic portal venous obstruction (EHPVO) with PCC. Methods: Prospectively recorded details of 620 (age 21.2 [11.4] years; 400 [65%] males) patients with primary EHPVO were reviewed. Outcomes (hepatic decompensation/mortality) of patients with PCC and SBO without shuntable veins were noted at follow up of 7 [4-11] years...
December 2017: Journal of Clinical and Experimental Hepatology
Li Long, Zhang Jinshan, Chen Zhen, Li Qi, Dong Ning, Diao Mei, Cheng Wei
OBJECTIVE: Rex shunt (mesenteric-to-left portal vein bypass) is considered a more physiologically rational treatment for EHPVO than other portosystemic systemic shunts in children. However, about 13.6% of children with EHPVO do not have usable left portal veins and up to 28.1%. Rex operations in children are not successful. Hence, a Rex shunt in these children was impossible. This study reports a novel approach by portal-to-right portal vein bypass for treatment of children with failed Rex shunts...
July 2018: Journal of Pediatric Surgery
Jin-Shan Zhang, Long Li, Wei Cheng
OBJECTIVE: Since 2008, the modified Rex shunt has been used for the treatment of extrahepatic portal venous obstruction (EHPVO) in our center, and satisfactory results were initially achieved. However, the postoperative recurrence rate gradually increased. We therefore performed a retrospective study to evaluate the outcome and identify the optimal procedure. METHODS: Between October 2008 and March 2016, 79 children with EHPVO underwent the Rex shunt in our hospital: 48 underwent the gastroportal shunt (GP), 26 underwent the portal cavernoma-Rex shunt with interposition of grafted portal vessel (PP), and 5 underwent a spleen-preserving splenoportal bypass (SP)...
November 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Shashidhar Achar, Hemonta Kumar Dutta, Rudra Kanta Gogoi
AIM: Extrahepatic portal vein obstruction (EHPVO) is characterized by features of recent thrombosis or portal hypertension with portal cavernoma as a sequel of portal vein obstruction. Imaging of spleno-portal axis is the mainstay for the diagnosis of EHPVO. The aim of this study is to analyze the role of imaging in the preoperative assessment of the portal venous system in children with EHPVO. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted on twenty children with EHPVO aged between 1 and 18 years over a period of 1 year...
July 2017: Journal of Indian Association of Pediatric Surgeons
Barjesh C Sharma, Shivakumar Varakanahalli, Jatinder P Singh, Siddharth Srivastava
BACKGROUND: Gastric varices (GV) are found in patients with portal hypertension. Incidence of bleeding from GV is relatively low, but is severe, and associated with higher mortality. AIMS AND OBJECTIVES: To compare the types of GV in cirrhosis vs. extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N -butyl-2-cyanoacrylate (NBC, glue) injection. METHODS: Four hundred and fifty-four patients undergone glue injection of GV for primary prophylaxis or control of bleeding for first episode of bleeding from GV between August 2010 and August 2015 were analyzed...
June 2017: Journal of Clinical and Experimental Hepatology
Richa Lal, Moinak Sen Sarma, Manish K Gupta
The two cornerstones of management for Extrahepatic portal vein obstruction (EHPVO) are endotherapy and surgery [Porto-systemic shunts (PSS)/Mesorex bypass (MRB)]. Endotherapy is the mainstay of treatment for acute variceal bleed control and has also been used extensively for secondary prophylaxis till variceal eradication is achieved. However, long-term follow-up beyond endoscopic eradication of esophageal varices (EEEV) indicates that there are numerous delayed bleed and non bleed sequelae of EHPVO, which merit surgery as a definitive procedure to decompress the hypertensive portal venous system...
September 2017: Indian Journal of Pediatrics
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