Sarin SK(1), Agarwal SR. Extrahepatic portal vein obstruction (EHPVO) is an important cause of noncirrhotic portal hypertension, especially in Third World. Endoscopic Management. S. K. Sarin, Cyriac Abby Philips, Rajeev Khanna tal vein obstruction (EHPVO), noncirrhotic portal fibrosis. (NCPF; or idiopathic PHT. Extrahepatic Portal Vein Obstruction (EHPVO). Nonā€Cirrhotic Shiv Kumar Sarin MD, DM. Director Treatment of chronic EHPVO in children.

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Portal biliopathy is the term used to describe cholangiographic abnormalities of the extrahepatic and intrahepatic bile ducts in patients with EHPVO. A longer interval up to 1 year and documentation of a patent shunt with decompressed collaterals on color Doppler or MR angiography may help in determining the optimum time for surgery. Nevertheless, a combination of band ligation followed by sclerotherapy has shown to be superior to either modality in children with EHPVO.

Sarin SK, Gupta R. Contrastingly in EHPVO, prothrombotic disorders and local factors around the portal srin are the incriminating factors. Side-to-side lienorenal shunt without splenectomy in noncirrhotic portal hypertension in children. Surgery is primarily indicated when endotherapy fails to control bleeding, in presence of gastric or ectopic varices not amenable to endoscopic management and with delayed sequelae like portal biliopathy and rectal varices.

Consensus on extra-hepatic portal vein obstruction.

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Surgical restoration of portal flow corrects procoagulant and anticoagulant deficiencies associated with extrahepatic portal vein thrombosis. Conventional shunts proximal or distal splenorenal are not possible in almost one-third of cases due to blockage of splenic vein SV or small SV. Thapa BR, Mehta S. The natural history of portal hypertensive gastropathy: Management of gastric varices and portal hypertensive gastropathy Gastric varices: Management of portal biliopathy Portal biliopathy is the term used to describe cholangiographic abnormalities of the extrahepatic and intrahepatic bile ducts in patients with EHPVO.

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Surgical shunts revert the complications secondary to PHT. Portal hypertension in north Indian children. Acute gastric variceal bleeding can be controlled with tissue glue N-acetyl-2butyl- yanoacrylate injection.

PHG classically described in cirrhosis.

Non-cirrhotic portal hypertension – diagnosis and management.

Liver function tests took 2 to 2. Proximal splenorenal shunts for extrahepatic portal ehpv obstruction in children. There are many postulated etiologies of EHPVO namely umbilical sepsis, umbilical vein catheterization, abdominal trauma, surgery, intra-abdominal sepsis, dehydration, congenital agenesis or atresia of portal vein. Shunt surgery should be ephvo for asymptomatic portal biliopathy in presence of another indication like growth failure, symptomatic hypersplenism or ectopic varices.

Regarding endotherapy for variceal bleeding, there is no doubt that band ligation is superior to sclerotherapy. Bleeding in extrahepatic portal vein obstruction.

This has been substantiated in other studies in children. The latter mechanism has been further substantiated by the fact that after conventional shunt surgery the levels of anticoagulant proteins tend to further go down. Bile duct obstruction due to portal biliopathy in extrahepatic portal hypertension: Portal obstruction in children. Growth failure, portal biliopathy and minimal hepatic encephalopathy are additional concerns in EHPVO.


Surgical guidelines for the management of extra-hepatic portal vein obstruction. The debate is whether to send a child for shunt surgery preferably Rex shunt immediately after controlling acute variceal bleeding with endotherapy or to continue endotherapy to prevent further bleed and to offer shunt surgery as and when the child needs it.

Portal hypertensive gastropathy in children with extrahepatic portal venous obstruction: Poddar U Borkar V.

Patients with choledocholithiasis and stricture will require multiple sessions of endoscopic therapy with balloon dilatation and stent placement. The low prevalence in pediatric studies clearly suggests that the duration of portal hypertension plays an important role in the development of rectal varices. Evolving consensus in portal hypertension.

This is the most physiological shunt as it ehhpvo the hepatic blood flow.

Non-cirrhotic portal hypertension – diagnosis and management.

After hemodynamic resuscitation all such patients should undergo endotherapy [either sclerotherapy EST or band ligation EVL ]. Deficiency of natural anticoagulant proteins C, S and antithrombin in portal vein thrombosis: Portal diversion for portal hypertension in children.

Aetiology and management of extrahepatic portal vein obstruction in children: Hence the management of EHPVO is no longer restricted to the management of variceal bleeding alone; it encompasses the management of growth failure, portal biliopathy, colorectal varices, massive splenomegaly with its associated complications like infarction, hypersplenism, physical disability due to pain, early satiety etc.