nach oben

Pediatric Surgery International

Erschienen in:

01.12.2023 | Original Article

Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance

verfasst von: R. Z. Yuldashev, M. M. Aliev, M. F. Maksudov, U. O. Khaydarov, Sh. Shokhaydarov

Erschienen in: Pediatric Surgery International | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To study the relationship between the angiographic pattern of extrahepatic portal vein obstruction (EHPVO) and its etiology and clinical manifestations.

Methods

Clinical, etiological, and angiographic findings in 155 children with EHPVO were reviewed. Anatomy of extrahepatic portal venous system (EPVS) was categorized into five imaging patterns. Assessment of the severity of esophageal and gastric varices (EV and GV) was performed by upper gastrointestinal endoscopy.

Results

Based on multislice CT angiography, most commonly observed pattern of EHPVO was type I (48.4%) and type II (29%). According to anamnesis, 68 (43.8%) children had pathological conditions in neonatal period. Of these, 35 (22.6%) had an umbilical vein catheterization, 11 (7.1%) had a history of omphalitis, and 9 (5.8%) had prolonged jaundice. Thirteen (8.4%) patients had various septic conditions in neonatal period and it was more common associated with widespread thrombosis throughout the EPVS (type 5)—28% of observations. Significantly lower risk of bleeding from EV (p = 0.01) was noted in children with type IV pattern, whereas children with type III and V patterns had higher grades of EV.

Conclusion

Angiographic pattern of portomesenteric occlusion may provide a clue to its etiology, and clinical manifestation, especially in children with widespread thrombosis throughout the EPVS.

Bertocchini A, Falappa P, Grimaldi C, Bolla G, Monti L, de Goyet JDV (2014) Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance. J Pediatr Surg 49(8):1268–1275. https://doi.org/10.1016/j.jpedsurg.2013.10.029CrossRefPubMed

Wani ZA, Bhat RA, Bhadoria AS, Maiwall R (2015) Extrahepatic portal vein obstruction and portal vein thrombosis in special situations: need for a new classification. Saudi J Gastroenterol 21(3):129–138. https://doi.org/10.4103/1319-3767.157550CrossRefPubMedPubMedCentral

Orloff MJ, Orloff MS, Girard B, Orloff SL (2002) Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years’ experience with portal-systemic shunt. J Am Coll Surg 194(6):717–728. https://doi.org/10.1016/s1072-7515(02)01170-5CrossRefPubMed

Stringer MD, Heaton ND, Karani J, Olliff S, Howard ER (1994) Patterns of portal vein occlusion and their aetiological significance. Br J Surg 81(9):1328–1331. https://doi.org/10.1002/bjs.1800810923CrossRefPubMed

Shah SR, Deshmukh HL, Mathur SK (2003) Extensive portal and splenic vein thrombosis: differences in hemodynamics and management. Hepatogastroenterology 50(52):1085–1089PubMed

Davenport M (2017) Portal hypertension: causes and medical management. In: Davenport M, Heaton N, Superina RA (eds) Surgery of the Liver, Bile Ducts and Pancreas in Children, 3rd edn. CRC Press, New York, pp 279–292

Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010) Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol 16(2):143–155. https://doi.org/10.3748/wjg.v16.i2.143CrossRefPubMedPubMedCentral

Grama A, Pîrvan A, Sîrbe C, Burac L, Ştefănescu H, Fufezan O, Bordea MA, Pop TL (2021) extrahepatic portal vein thrombosis, an important cause of portal hypertension in children. J Clin Med 10(12):2703. https://doi.org/10.3390/jcm10122703CrossRefPubMedPubMedCentral

Abd El-Hamid N, Taylor RM, Marinello D, Mufti GJ, Patel R, Mieli-Vergani G, Davenport M, Dhawan A (2008) Aetiology and management of extrahepatic portal vein obstruction in children: King’s College Hospital experience. J Pediatr Gastroenterol Nutr 47(5):630–634. https://doi.org/10.1097/MPG.0b013e31817b6eeaCrossRefPubMed

10.

Heller C, Schobess R, Kurnik K, Junker R, Günther G, Kreuz W, Nowak-Göttl U (2000) Abdominal venous thrombosis in neonates and infants: role of prothrombotic risk factors–a multicentre case-control study. For the childhood thrombophilia study group. Br J Haematol 111(2):534–539. https://doi.org/10.1111/j.1365-2141.2000.02349.xCrossRefPubMed

11.

Bayraktar Y, Harmanci O (2006) Etiology and consequences of thrombosis in abdominal vessels. World J Gastroenterol 12(8):1165–1174. https://doi.org/10.3748/wjg.v12.i8.1165CrossRefPubMedPubMedCentral

12.

Di Giorgio A, De Angelis P, Cheli M, Vajro P, Iorio R, Cananzi M, Riva S, Maggiore G, Indolfi G, Calvo PL, Nicastro E, D’Antiga L (2019) Etiology, presenting features and outcome of children with non-cirrhotic portal vein thrombosis: a multicentre national study. Dig Liver Dis 51(8):1179–1184. https://doi.org/10.1016/j.dld.2019.02.014CrossRefPubMed

13.

Zhang JS, Li L (2020) Imaging features and clinical relevance of portal venous systems shown by extrahepatic portal angiography in children with extrahepatic portal venous obstruction. J Vasc Surg Venous Lymphat Disord 8(5):756–761. https://doi.org/10.1016/j.jvsv.2019.11.016CrossRefPubMed

14.

Köklü S, Coban S, Yüksel O, Arhan M (2007) Left-sided portal hypertension. Dig Dis Sci 52(5):1141–1149. https://doi.org/10.1007/s10620-006-9307-xCrossRefPubMed

15.

Hayashi H, Shimizu A, Motoyama H, Kubota K, Notake T, Ikehara T, Yasukawa K, Kobayashi A, Soejima Y (2020) Left-sided portal hypertension caused by idiopathic splenic vein stenosis improved by splenectomy: a case report. Surg Case Rep 6(1):148. https://doi.org/10.1186/s40792-020-00912-yCrossRefPubMedPubMedCentral

16.

Weiss B, Shteyer E, Vivante A, Berkowitz D, Reif S, Weizman Z, Bujanover Y, Shapiro R (2010) Etiology and long-term outcome of extrahepatic portal vein obstruction in children. World J Gastroenterol 16(39):4968–4972. https://doi.org/10.3748/wjg.v16.i39.4968CrossRefPubMedPubMedCentral

17.

Williams S, Chan AK (2011) Neonatal portal vein thrombosis: diagnosis and management. Semin Fetal Neonatal Med 16:329–339. https://doi.org/10.1016/j.siny.2011.08.005CrossRefPubMed

18.

Macartney CA, Chan AK (2011) Thrombosis in children. Semin Thromb Hemost 37:763–761. https://doi.org/10.1055/s-0031-1297167CrossRefPubMed

19.

Di Giorgio A, De Angelis P, Cheli M, Vajro P, Iorio R, Cananzi M, Riva S, Maggiore G, Indolfi G, Calvo PL, Nicastro E, D’Antiga L (2019) Etiology, presenting features and outcome of children with noncirrhotic portal vein thrombosis: a multicentre national study. Dig Liver Dis 51:1179–1184. https://doi.org/10.1016/j.dld.2019.02.014CrossRefPubMed

20.

Gibelli NE, Tannuri AC, Pinho-Apezzato ML, Maksoud-Filho JG, Tannuri U (2011) Extrahepatic portal vein thrombosis after umbilical catheterization: is it a good choice for Rex shunt? J Pediatr Surg 46(1):214–216. https://doi.org/10.1016/j.jpedsurg.2010.09.091CrossRefPubMed

21.

Bersani I, Piersigilli F, Iacona G, Savarese I, Campi F, Dotta A, Auriti C, Di Stasio E, Garcovich M (2021) Incidence of umbilical vein catheter-associated thrombosis of the portal system: a systematic review and meta-analysis. World J Hepatol 13(11):1802–1815. https://doi.org/10.4254/wjh.v13.i11.1802CrossRefPubMedPubMedCentral

22.

Figueroa-Sánchez M, Nuño-Guzmán CM, Álvarez-López MC, Ordónez-Cárdenas M, Montaño-Rodríguez LJ (2022) Case report: splanchnic vein thrombosis as a complication of necrotizing acute pancreatitis in a pediatric patient. Front Surg. 9:747671. https://doi.org/10.3389/fsurg.2022.747671CrossRefPubMedPubMedCentral

23.

Nadkarni NA, Khanna S, Vege SS (2013) Splanchnic venous thrombosis and pancreatitis. Pancreas 42(6):924–931. https://doi.org/10.1097/MPA.0b013e318287cd3dCrossRefPubMed

24.

di Francesco F, Del Prete L, Grimaldi C, Monti L, de Goyet JDV (2015) Pancreatitis and portal vein thrombosis in children: the chicken or the egg causality dilemma. J Pediatr Surg 50(4):565–9. https://doi.org/10.1016/j.jpedsurg.2014.11.039CrossRefPubMed

25.

Bouchoucha S, Benghachame F, Trifa M, Saied W, Douira W, Nessib MN, Ghachem MB (2010) Deep venous thrombosis associated with acute hematogenous osteomyelitis in children. Orthop Traumatol Surg Res 96(8):890–893. https://doi.org/10.1016/j.otsr.2010.05.006CrossRefPubMed

26.

Lee CY, Lee YS, Tsao PC, Jeng MJ, Soong WJ (2016) Musculoskeletal sepsis associated with deep vein thrombosis in a child. Pediatr Neonatol 57(3):244–247. https://doi.org/10.1016/j.pedneo.2013.09.004CrossRefPubMed

27.

Mantadakis E, Plessa E, Vouloumanou EK, Michailidis L, Chatzimichael A, Falagas ME (2012) Deep venous thrombosis in children with musculoskeletal infections: the clinical evidence. Int J Infect Dis 16(4):e236–e243. https://doi.org/10.1016/j.ijid.2011.12.012CrossRefPubMed

28.

Gite A, Trivedi R, Ali US (2008) Deep vein thrombosis associated with osteomyelitis. Indian Pediatr 45(5):418–419PubMed

29.

Childhood Liver Disease Research Network (ChiLDReN), Bass LM, Shneider BL, Henn L, Goodrich NP, Magee JC (2019) Clinically evident portal hypertension: an operational research definition for future investigations in the pediatric population. J Pediatr Gastroenterol Nutr 68(6):763–767. https://doi.org/10.1097/MPG.0000000000002333CrossRef

Titel: Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance
verfasst von: R. Z. Yuldashev
M. M. Aliev
M. F. Maksudov
U. O. Khaydarov
Sh. Shokhaydarov
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 1/2023
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05384-3

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Pädiatrie

Neuer Typ-1-Diabetes bei Kindern am Wochenende eher übersehen

Neue Studienergebnisse zur Myopiekontrolle mit Atropin

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Pädiatrie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2023

Spinal cord anomalies in children with anorectal malformations: a retrospective cohort study

Discriminatory capacity of serum total bilirubin between complicated and uncomplicated acute appendicitis in children: a systematic review and a diagnostic test accuracy meta-analysis

Robot-assisted laparoscopic varicocelectomy in a pediatric population

Nomogram for predicting fulminant necrotizing enterocolitis

Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis

Letter to the editor re: Malla et al. Management dilemma in pelvi-ureteric junction obstruction: is cortical transit time the answer?

Neu im Fachgebiet Pädiatrie

Neuer Typ-1-Diabetes bei Kindern am Wochenende eher übersehen

Neue Studienergebnisse zur Myopiekontrolle mit Atropin

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Pädiatrie