Journal of Pediatric Gastroenterology & Nutrition:
ABSTRACTS: Oral Presentation Abstracts
1Pediatric Department, 2Tropical Medicine Department, Faculty of medicine Cairo university, 3Tropical Medicine Department, Fayoom faculty of medicine, 4Radiology Department, Faculty of medicine Cairo university, Cairo, Egypt
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Introduction: 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 was to analyze the data of children with prehepatic portal hypertension secondary to PVT presenting to the Pediatric Hepatology Unit, Cairo University, Egypt.
Methods: 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.
Results: The male: female ratio was 1.4:1, with ages ranging between 1–18 years. The most important presenting symptoms were: hematemesis and/or melena in 52.5%, abdominal distention in 25% and accidentally detected splenomegaly in 15%. 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%. Ultrasonography was diagnostic in 98% and the remaining 2% were diagnosed by Doppler examination. In contrast, out of 40 children with portal vein occlusion detected by ultrasonography, 12 showed patent portal vein by Doppler examination. Upper gastrointestinal endoscopy revealed esophageal varices in 91%. Therapeutic sclerotherapy and band ligation was done for 74.2%, and 12.5% respectively. Prophylactic sclerotherapy was performed in 6.7% and only one case underwent prophylactic band ligation.
Conclusion: Prehepatic portal hypertension presents early in life commonly with bleeding esophageal varices. Ultrasonography is an indispensable diagnostic tool. Successful treatment of bleeding varices can be carried out endoscopically by sclerotherapy and band ligation.