Mesoportal shunt reconstruction in a 10-year-old child with extrahepatic portal hypertension

Abstract

Purpose. The basic management task of children with extrahepatic portal hypertension (EHPH) is to prevent bleeding from intestinal and gastric protuberant varicosities. Materials and methods. Meso-portal shunting doesn’t only prevent bleedings from varicose veins, but also restores normal anatomical and physiological relations within the basin of the portal vein. The Clinical Hospital No. 13 has the largest experience of treating patients with EHPH. From 1989 to 2017 we observed 789 patients with portal hypertension aged 2.5 months to 17 years. 23.5% of them included children under 3 years old. Since 2000, meso-portal shunting was done in 261 children. 239 (91.6%) patients had an excellent result such as reduction of varicose veins and restored portal hepatic perfusion. Discussion. A clinical case of a 9-year-old child diagnosed with extrahepatic portal hypertension was presented. The girl underwent meso-portal shunting. However, no reduction of intestinal varicose veins was presented during the post-operative period. Meso-portal shunting stenosis was found during an angiographic study. The child had another operation; stenosis of meso-portal shunt was diagnosed, a narrowed section was resected with subsequent restoration of vascular insertion patency. During the postoperative period, varicose veins disappeared completely. Conclusion. The presented clinical example displays modern surgical possibilities of portal hypertension in children even in such complicated cases as stenosis of vascular venous anastomosis occurring following MPS approximately in 10% of cases.

Keywords

portal hypertension / children / intestinal varicose veins / meso-portal shunting / recurrent surgeries

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RIGHTS & PERMISSIONS

Razumovsky A.Y., Mitupov Z.B., Alkhasov A.B., Galibin I.E., Feoktistova E.V., Rachkov V.E.