ABSTRACT
Background: Portal vein thrombosis [PVT] is considered the most important etiology of prehepatic portal hypertension in children and a leading cause of esophageal varices and hematemesis in these children
Aim of the study: The aim is to analyze the data of children with prehepatic portal hypertension secondary to PVT presenting to the Pediatric Hepatology Unit, Cairo University. Egypt. Study design. The study included 120 children with PVT who presented during the period 1987-2002. They were retrospectively analyzed for the presenting symptoms, the risk factors for the development of PVT, the diagnostic tools and the therapeutic measures carried out for them. Most of them 114/120 were followed up for variable periods. [ranging from 2 months to 12 years]
Results: The male: female ratio was 1.4:1, with ages ranging between 1-18 years. The most important presenting symptoms were: hematemesis in 32%, abdominal distention in 25% and accidentally detected splenomegaly in 181%.Risk factors for the development of PVT included: neonatal sepsis: 3.3%, umbilical catheterization: 5.8%, umbilical sepsis: 5% and severe gastroenteritis and dehydration 1 7%, while there was no risk factor detected in 81%. Ultrasonography was diagnostic in 99% and the remaining 1% were diagnosed by Doppler examination. In contrast, out of 36 children with portal vein occlusion detected by ultrasonography, 9 showed patent portal vein by Doppler examination. Upper gastrointestinal endoscopy revealed esophageal varices in 91% Therapeutic sclerotherapy and band ligation were done for 74.2%, and 13.3% respectively. Prophylactic sclerotherapy was performed in 7.5% and only one case underwent prophylactic band ligation
Conclusion: Prehepatic portal hypertension presents early in life commonly with bleeding esophageal varices. Ultrasonography is a helpful diagnostic tool. Sclerotherapy and band ligation are the most important therapeutic measures in the present study
ABSTRACT
Acute upper gastrointestinal bleeding continues to be a common cause of hospital admission and morbidity and mortality. Bleeding esophageal varices is a life - threatening complication in children with portal hypertension. This study is a one year retrospective study presenting the results and experiences with 937 fiber optic oesophagogastro-duodenoscopies [EGD], which were performed at the Endoscopy Unit in Cairo University Pediatric Hospital [CUPH] between August 2003 and July 2004. We aimed at identifying the prevalence of esophageal varices among children subjected to upper endoscopic examination, and to outline the possible cause of portal hypertension in this group of patients. Among the 937 UGEs done for 730 patients, 313 [33.4%] revealed esophageal varices. Theses were done for 147 patients with some male predominance, where 88[59.8%] patients were males and 59 [40.1%] were females, their ages ranged between 7 months and 14 years. Eighty three [56.5%] of the 147 patients with esophageal varices were diagnosed as having prehepatic portal hypertension secondary to portal vein thrombosis [PVT] and the remaining 64 [43.5%] had intrahepatic catases for portal hypertension. Hematemesis occurred more frequently and earlier in the former group who were also lacking stigmata of liver disease. Esophageal varices were encountered in one third of the studied patients. A baby presenting with hematemesis and lacking stigmata of liver disease, particularly jaundice and hepatomegaly, should be suspected of having PVT and an endoscopist experienced in sclerotherapy and/or band variceal ligation in this young age has to perform the upper endoscopy