pediatric patient portal vein obstruction

Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients.

Full Answer

What is extra hepatic portal venous obstruction in children?

Introduction: Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery …

What is portal vein obstruction (PVO)?

Dec 01, 2021 · Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery …

What is extrahepatic portal vein obstruction?

Background: Extrahepatic portal vein obstruction (EHPVO) causes portal hypertension in noncirrhotic children. Among surgical treatments, it is unclear whether the meso-Rex shunt (MRS) or portosystemic shunt (PSS) offers lower post-operative morbidity and …

How is growth impairment improved in children with extrahepatic portal vein obstruction?

EHPVO is characteristically refers to obstruction in the trunk of portal vein and it can extend to its branches and even splanchnic veins. Unlike cirrhosis, in EHPVO, the liver function is normal. The causes of portal venous obstruction and risk factors for upper gastrointestinal hemorrhage in children with EHPVO are not clearly understood.

What happens if portal vein is blocked?

Portal vein thrombosis is blockage or narrowing of the portal vein (the blood vessel that brings blood to the liver from the intestines) by a blood clot. Most people have no symptoms, but in some people, fluid accumulates in the abdomen, the spleen enlarges, and/or severe bleeding occurs in the esophagus.

What causes portal vein thrombosis in child?

Children. In children and neonates, the most common etiology is intra-abdominal infection, accounting for 50% of all cases in this age group. Neonatal sepsis with umbilical catheter placement has been reported to be the cause of portal vein thrombosis in 10-26% of cases.Jul 9, 2020

What causes portal hypertension in a child?

Prehepatic blockages are the most common cause of portal hypertension in children. They stem from blood clots or narrowing of the portal vein before it reaches the liver. In response, the body grows varices that bypass the blockage.

What causes a blocked portal vein?

Portal vein obstruction most commonly results from thrombosis or, to a lesser extent, from malignancy. It also occurs as a complication of several metabolic and autoimmune diseases. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are the mainstays of treatment.Jan 14, 2022

What is the treatment for portal vein thrombosis?

TREATMENT OF PORTAL VEIN THROMBOSIS [1,4] This is most often performed through continuous intravenous heparin infusion, but some authors report using low-molecular-weight heparin. Chronic treatment options include warfarin or low-molecular-weight heparin.

What are the symptoms of portal vein thrombosis?

Other severe symptoms of portal vein thrombosis include:spiking fevers.chills.liver pain.vomiting blood.yellowing of the skin, or jaundice.varices and gastric bleeding.bloody or tarry stools.Oct 24, 2017

How is portal hypertension treated?

Healthcare providers treat portal hypertension in several ways:Medicines. You may need to take medicines called beta blockers. These improve how your heart and blood vessels work. ... Shunting. If you have a severe case, you may need shunting. ... Liver transplant. This treatment may be needed if you have liver failure.

What are the complications of portal hypertension?

Although many advances have been made in this field, the complications of portal hypertension (gastrointestinal hemorrhage, hepatic encephalopathy, hepatorenal syndrome, and ascites) continue to be the cause of significant morbidity and mortality.

What causes portal vein hypertension?

The most common cause of portal hypertension is cirrhosis, or scarring of the liver. Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse or other causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.Nov 16, 2017

What is Portal cavernoma?

Cavernous transformation of the portal vein (portal cavernoma) is a rare condition consisting of portosystemic or portoportal collaterals that substitute for a thrombosed portal vein.Aug 30, 2007

What organs does the hepatic portal vein drain?

The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents.

Is portal hypertension life threatening?

Portal hypertension is a dangerous condition with severe, life-threatening complications. Call your healthcare provider right away if you notice any of these symptoms: Yellowing of the skin. Abnormally swollen belly.

Abstract

Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients.

1. Introduction

Liver transplantation (LT) is the standard care for patients with end-stage liver disease and liver failure [ 1 ].

3. Results

The search resulted in 135 studies after duplicates were removed ( Fig. 1 ). After titles and abstracts were screened, 86 studies remained, of which 64 were excluded during the full-text assessment based on the inclusion and exclusion criteria.

4. Discussion

We report the first systematic review on endovascular or surgical treatment, or both, for PVO after pediatric LT. We concentrated on the biochemical and clinical characteristics at the intervention and the efficacy of the procedures applied.

5. Conclusion

We performed the first review of all treatment protocols in pediatric PVO patients after LT. We showed that an important group of patients treated for PVO has severe symptoms of portal hypertension (16% ascites and 26% gastrointestinal bleeding) and attempted to combine the varying protocol into a more uniform one.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authorship

Alfares: Helped design the work, acquired the data, conducted the analysis, interpreted the results and drafted the manuscript. Bokkers and van der Doef: Conceived and designed the work, revised the acquired data, and played an important role in the interpretation of the results; revised the manuscript, approved the final version.

METHODS

Thirty-three consecutive prepubertal children (23 boys and 10 girls) seen in the pediatric gastroenterology service of our hospital and diagnosed to have EHPVO were enrolled in the study. They were aged 1.5 to 12 years, with a median age of 7 years.

RESULTS

All patients included in the study had normal hemoglobin levels, as well as normal liver functions including serum protein. When compared with reference data derived from well-nourished Indian children, 18 of the 33 patients (54.5%) were below the 5th percentile in height, compared to 2 of 35 controls (5.7%, p < 0.0001).

DISCUSSION

In this study of children with EHPVO, we have confirmed the presence of growth retardation not attributable to anemia, undernutrition, or deranged liver functions. The widely accepted anthropometric index of active undernutrition or “wasting” is weight for height.

REFERENCES

1. Dilawari JB, Chawla YK, Ramesh GN, Mitra SK, Walia BNS. Endoscopic sclerotherapy in children. J Gastroenterol Hepatol 1989;4:155-60.