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