Abstract
Background: EHPVO is an important problem in children. To find out incidence / investigational profile, clinical and therapeutic outcome of children with EHPVO with following study was performed.
Method: The children (<12 years) who were admitted in Pediatric GE ward of PGIMER Chandigarh with history of UGI bleed suggestive of EHPVO from July 1993 to June 2003 were noted. Age / sex / clinical details like Haematemesis / Melaena / Splenomegaly / feature of liver disorder (ascites / jaundice / HE etc) / growth parameters / Neonatal history of umbilical catheterization / sepsis / investigation like USG whole abdomen / LFT / PT / Hemogram / UGI Endoscopy etc were noted.
Results: Out of 50 cases of EHPVO, 30 were male and 20 female. Age was 3 – 12 years (mean 6 years). History of umbilical catherisation / sepsis were present in 6% cases. Fifty out of 50 (100%) came with Haematemesis / 30 (60%) with combined Haematemesis / Melaena. There was no feature of liver failure in any case. USG shows normal hepatic echo texture with 40 cases (80%) having portal cavernoma, 30 (60%) having both portal cavernoma and splenic collateral, 10 (20%) having peri cholecystic collateral. Splenomegaly was present in all cases (100%). There was no colorectal Varix or Hemorrhoid. Gastic varix develop only after EVL / EST of Esophageal varix in 10 (20%) cases. EVL was successfully done 40 (80%) cases but 10 cases (20%) required EST due to technical problem. 5 (10%) cases required distal splenorenal shunt. All patients of EHPVO recovered from portal hypertension but 10 (20%) had growth failure.
Conclusion: EHPVO being important cause of portal hypertension requires urgent management.
References
- Management of extrahepatic portal venous obstruction (EHPVO), Current strategies, Review article, Poddar U et al, Trop Gastroenteroe 2011, April – June
- Extrahepatic portal venous obstruction, Review Article, Sarin SK et al, Semin Liver Dis 2002
- Etiological spectrum of esophageal varices due to portal hypertension in Indian children. Is it different from West?, Poddar U et al, J. Gastroenterol Hepatol 2008.
- Band ligation plus selero therapy Vs sclerotherapy alone in children with extrahepatic portal vein obstruction., Poddar U et al, J. Clin Gastroenterol 2005
- Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with EHPVO, Zargar SA et al, Hepatology 2002
- Endoscopic outcome beyond esophageal variceal eradication in children with EHPVO, Itha S et al, J. Gastroenterology Nutrition 2006
- Endoscopic sclerotherapy for esophageal varix in children with EHPVO – A FOLLOW UP STUDY, Yachcha Sk et al J. Pediatric Gastroenterology Nutrition 1997
- 15 yrs follow up of endoscopic sclerotherapy in children with EHPVO, Zargan SA et al, J. Gastroenterol Hepatol 2004
- Frequency of Gastroesophageal and gastric varix in children with EHPVO treated with sclerotherapy, Poddar U et al, J. Gastroenterol Nutrition 2004
- Non cirrhotic portal hypertension, Review article, Sarin SK, Clin Liver Dis 2014
- Non cirrhotic portal hypertension – Diagnosis and management, Khama R et al J. Hepatol 2014
- Non cirrhotic portal fibrosis – current concept and management, Sarin SK et al, J. Gastroenterol Hepatol 2002
- Non cirrhotic portal hypertension Vs idiopathic portal hypertension, Okuda K J. Gastroenterol Hepatol 2002
- Cavernous transformation of portal vein – pattern of intrahepatic and splanchnic collateral circulation detected by colour Doppler study. De Gaetano AM, AJR 1995, Nov 165 / 51, 1151 – 1155
- Surgical management of portal hypertension in children., De Vile De Goyet J et al, Semi pediatric surgery 2012
- Mesenteric Lt portal vein bypass in children with congenital EHPVO – an unique curative approach. Francis J et al J. pediatric Gastroenterol Nutrition 2003
- Experience with Rex shunt Mesenteric Lt portal bypass) in children with EHPVO Bambimi DA et al J. pediatric Surgery 2000
- Advantage of Meso Rex bypass compared with porto systemic shunt in management of extrahepatic portal veinous obstruction in children, Lantz TB et al, J. Am Coll Surgery 2013
- Metabolic profile of children with EHPVO undergoing Meso Rex bypass, Lantz TB et al, J. Surgery Res 2018
- Recanalised umbilical vein conduit for Meso Rex bypass in EHPVO, Faccinto ME et al, Surgery 2009
- Etiology and long term out-come of EHPVO in children. Weiss B et al, World J. Gastroenterol 2010
- Colorectal variceal bleed in patient with EHPVO, Ovozcolt et al, J. Clinic Gastroenterol 1992, March 14 (2), 139 – 43
- Bleeding esophago gastric Varix from EHPVO – 40 Yrs experience with porto systemic shunt. Orloff M et al J. Am College Surgery 2002, June 199 (6), 717 – 28
- Endoscopic variceal ligation Vs endoscopic variceal ligation and endoscopic sclera therapy prospective randomized study, Blurgara D K, Am J. Gastroenterol 1997, June 92 (2), 950 – 3
- Surgical guideline for management of EHPVO, Superina R et al, Ped. Transplant 2006, Dec 10 (8), 908 – 13.
- Hepatic dysfunction in patients with EHPVO, Raregani M, Liver Int 2003, Dec 23 (6), 934 – 9
- Natural History of minimal HE in patient with EHPVO, Sharm P, Am J. Gastroenterol 2009, April 104 (4) 855 – 90
- Do umbilical vein catheterization and sepsis lead to portal vein thrombosis? A prospective clinical and sonographic evidence Yadav S. et al J. pediatric Gastroenterol Nutrition 1993
- Meso portal bypass for EHPVO in children – close to a cure for most J. pediatric surgery 2010 Sharif K et al
- Profile of EHPVO in Mumbai, Bhandekar PV J. Asoc. Physician India 1999, April 47 (8), 791 – 4
- Clinical and Lab difference of cirrhosis and EHPVO in children, Peter L., J. Gastroenterol Hepatol 2003, Feb 18 (2), 185 – 9
- Porto systemic shunt in children – 15 yrs. Experience Botha JF et al, J. Am coll Surgery 2004
- Mesentero Lt. portal bypass for variceal bleeding owing to EHPVO caused by portal vein thrombosis. Ates O et al, J. pediatric Surgery 2006
- Mesenteric Lt. portal vein bypass in in children with congenital EHPVO – unique procedure. Fluchs J. et al, J. Pediatric Gastroenterology Nutrition 2003
- Perioperative strategies and thrombophilia in children with EHPVO undergoing Meso Rex bypass, Blat R et al, J. Gastro intestinal Surgery 2013
- Systemic and Pulmonary hemodynamic in patient with EHPVO is similar to compensated cirrhosis, Sanjeev kumar Jha et al, Hepatology International 2009, June 3 (2), 384 – 390.
- Etiology of portal hypertension in children – a single centre’s experience Middle East J. Dig Dis 2012, Oct 4 (4), 206 – 10
- A prospective randomized controlled trial of sclera therapy Vs ligation in prophylactic treatment of Esophageal Varix Srobuda P. ety al, Surgery Endoscopy 199
- EVL Vs EVL + EST – Prospective randomized study, Bhargava D K et al, Am J. Gastroenterol 1997
- Study of portal hypertension in children with special reference to sclera therapy Gamys S. et al Trop Gastroenterol 1997 July – September.
Corresponding Author
Sujay Chaudhuri
Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER Chandigarh
DOI: https://dx.doi.org/10.18535/jmscr/v8i2.128
