Portal vein thrombosis in Sudanese children

Portal Vein Thrombosis [PVT] is one of the most common causes of portal hypertension among children in Sudan. To determine the incidence, aetiology and mode of presentation of PVT among children and find its relation to gastrointestinal bleeding in a Sudanese hospital. This is a prospective hospital based study conducted at a tertiary care paediatric hospital in Khartoum, Sudan [Gaffer Ibn Oaf Specialized Children Hospital [GIO]]. 350 children were diagnosed on clinical grounds [heamatemiss, splenomegaly] to have portal hypertension. After laboratory investigations [CBC, LFTs, coagulations profile and RFTs], abdominal sonography with Doppler, 275 patients turned to have portal vein thrombosis. Upper GI endoscopy was done for all patients and liver biopsy when indicated. Data were analysed, discussed and conclusion were reached. Out of 800 children presented with upper GI bleeding 350 were diagnosed as having esophageal varices bleeding due to portal hypertension [44%], out of these 250 [70%] children were found to have PVT as a cause of their portal hypertension, and another 25 children were diagnosed to have PVT without GI bleeding. Their ages ranged between 4 month and 16 years. Two hundred were males. Seventy five were below one year of age. History of risk factor for PVT was found only in 68 children. All the bleeders had sclerotherapy, band ligation or both beside propranolol and H2 blockers or PPI. Time for follow up was between 6 month to 4.5 years. 150 children cleared their varices with 4-6 cession of either sclerotherapy, banding or both, the rest of the children are still receiving sclerotherapy. Ten children received liver support for portal biliopathy, five children had splenectomy because of hypersplenism. Four children died. Propranolol was stopped in 50 children out of 150 children who cleared their varices after two years Conclusions: PVT in children is common in Sudanese children, and represents the second common cause of upper GI bleeding. Its aetiology is obscure in the majority of cases and more studies and facilities are needed to uncover the underlying cause. Simple clinical data, ultrasonography and upper GI endoscopy are quite adequate measures to reach accurate diagnosis. Combinations of endoscopic sclerotherapy and band ligations with propranolol are very effective in controlling the bleeding of the esophageal varices, though it has a remarkable effect on the quality of life of affected children. Thus appropriate medical alternative or surgical treatments are needed in order to reduce morbidity and mortality and improve the quality of life of these patients

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ration was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], billary Atresia [10%], chornic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in [4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinoma is significantly high in our pediatrics population

Result of eradication of esophageal varices in children with extra hepatic portal venous obstruction in Sudan

Extra hepatic Portal Vein Thrombosis is the main cause of Portal hypertension in children in Sudan, which is responsible for almost 30% of heamatemsis in children in Sudan. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding [which results from the rupture of esophageal varices] which is usually a combination of endoscopic sclerotherapy and/or band ligation to eradicate the varices, Porto systemic shunting in selected cases, medical prophylaxis, and to support the child growth and development. In this study we looked beyond the eradications of the varices in these children to help us providing a better long term care plan for such an important problem. The Objectives are to find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy [PHG] and risk of rebleeding following esophageal variceal eradication in children with Extra hepatic Portal Vein Obstruction [EHPVO]. Between March 2005 and March 2010, children with extra hepatic portal venous obstruction [EHPVO] and bleeding from esophageal varices who referred to the Gastroentrology unit at Gafaar In Oaf Specialized Children Hospital, Khartoum, Sudan, and the Endoscopic unit of the Military hospital, Omderman, Sudan received endoscopic injection sclerotherapy [EIS] and /or Esophageal Varices Band Ligation [EVBL] until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal [GOV] or isolated gastric varices [IGV]. Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. The therapeutic endoscopy procedures were done by the two authors. 113 of 133 children who achieved esophageal varices eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices [before EIS/EVBL] were seen in 61% cases [GOV98% [83% GOV1, 15%GOV2] and IGV2%] and secondary gastric varices [after EIS/EVBL] in 28% [GOV 71% [47% GOV1, 24% GOV2] and IGV 29%]. Secondary gastric varices were distributes as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy or/and banding, at the last follow up showed decrease in GOV1 from 57to 39 [P=0.01], increase in GOV2 from 10 to 16 and increase in IGV from 1 to 10 [P<0.001]. PHG increased in frequency from 12% to 41% [P<0.001] and severity from one patient to 12 [P<0.001]. Eight cases had rebleeding from gastric varices [4 GOV1, 3 GOV2 and 1 IGV]. It was conclude that following esophageal variceal eradication in children with EHPVO a significant decrease in Gastroesophageal Varices, increase in Isolated Gastric Varices and increased frequency and severity of Portal hypertensive Gastropathy takes place. Small rebleeding risk persists from gastric varices irrespective of the type

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ratio was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], Billary Atresia [10%], chronic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5%], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in[4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinam is significantly high in our pediatrics population

Causes of portal hypertension in Sudanese children

The etiological profile of Pediatric Portal hypertension in our hospital, Gafaar Ibn Oaf Specialized Children Hospital a tertiary referral children hospital for the whole of Sudan, showed that the commonest causes were extra hepatic portal venous obstruction [EHPVO] and liver cirrhosis. Cryptogenic liver cirrhosis was the most common cause of cirrhosis

Liver biopsy: is it safe in children?

The blind liver biopsy technique has been widely used in Sudan as the availability of the ultra sound machines and the committed Pediatrics Radiologist were not always at hands. Liver biopsy is an essential tool in the diagnosis of liver diseases and subsequently, initiating the appropriate treatment. The aim of the study was to observe the safety of blind liver biopsy in our children. One hundred fifty consecutive liver biopsies in hospitalized children were evaluated retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostals space blind liver biopsies were performed by TruCut biopsy needle. The study was conducted at Gafaar Ibn Oaf Specialized Children Hospital ,Khartoum Sudan, over the last five years, between January 2005-January 2010. The first biopsy sample was considered macroscopically adequate in 94.8% of cases. A definitive histological diagnosis was possible in 99.1% of cases. seventy children were more than 5 years of age and of these 8 [11.4%] complained of pain at the biopsy site, external hemorrhage from the biopsy site was seen in 1 [0.6%] case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure. Blind liver biopsy in the studied hospitalized children was found to be a safe procedure

Transient glutenopathy and abdominal tuberculosis; a cause or effect? preliminary report

Tuberculosis remains an important disease worldwide. It is difficult to estimate its incidence In children. The association between intestinal tuberculosis and glutenopathy was not reported before. Three hundred patients who presented with chronic diarrhea to Oaafar Ibn Auf Specialized Children Hospital, Khartoum Sudan were investigated for intestinal tuberculosis and gutenopathy. The children were divided into two groups both were put on treatment for tuberculosis. However, one group was put on gluten free diet as well. The serological markers and intestinal biopsies were taken initially, six months after commencement of treatment and six months later. Also their clinical response to treatment was encountered. Out of the 300 children who presented with chronic diarrhea, 30 were diagnosed to have intestinal tuberculosis. Their ages ranged between 2-10 years. At commencement of the study all the patients [30] had positive IgA and IgG antigliadin antibodies and anti tTG [table I]. The group which was put on gluten free diet showed rapid clinical, biochemical and histological response. Despite the limitation of this preliminary study; we can conclude that ITS can cause transient glutenopathy and gluten free diet may facilitate clinical recovery in patients with ITB