Trombose de veia porta em crianças e adolescentes

Abstract

Objective: To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. Sources of data:The medical literature of the past 10 years was reviewed using the PubMed and MEDLINE search engines, with major focus on portal vein thrombosis and its clinical outcomes. The following keywords or expressions were used for the web search: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Additionally, we also reviewed the articles cited in the references of the initially selected papers, as well as relevant textbooks.Summary of the findings: Portal vein thrombosis is one of the most common causes of portal hypertension among children. The initial clinical manifestation is characterized either by episodes of upper gastrointestinal bleeding or by splenomegaly on routine clinical examination. The major complications include upper gastrointestinal bleeding, hypersplenism secondary to splenomegaly, growth retardation, and portal biliopathy. The diagnosis is made by abdominal Doppler ultrasonography. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding (which results from the rupture of esophageal varices), and portosystemic shunting in selected cases.Conclusions: Portal vein thrombosis is one of the major triggers of upper gastrointestinal bleeding in children. Bleeding episodes have a remarkable effect on the quality of life of affected patients. Thus, appropriate diagnosis and treatment are needed in order to reduce morbidity and mortality.

Avaliação da média de ressangramento em pacientes pediátricos com trombose da veia porta que fizeram uso de profilaxia endoscópica e/ou medicamentosa

“…A ruptura das varizes esofágicas está relacionada a uma elevada taxa de morbimortalidade, afetando também os familiares que tornam-se ansiosos em relação a imprevisibilidade de outro sangramento. A abordagem é dividida da seguinte forma: profilaxia primária para prevenir um episódio inicial de hemorragia varicosa, tratamento de episódios hemorrágicos agudos e profilaxia secundária para prevenir hemorragias recorrentes 27 . Os métodos profiláticos disponíveis englobam modalidades farmacológica, terapia endoscópica e cirúrgica.…”

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

“…5 Compensatory mechanisms are activated in response to interruption of this flow, including reflexive vasodilation of the hepatic artery and formation of collateral vessels, allowing blood to bypass the site of obstruction. 15,16 Etiologies of PVT other than those related to cancer and cirrhosis 17 include vascular malformations and hypercoagulable states, 1 such as deficiencies of antithrombin III or deficiencies of protein C and protein S, dysfibrinogenemia, and the G20210A prothrombin gene mutation. 1,5,17,18 Around 60% of patients with mesenteric thrombosis have a history of DVT.…”

Trombose de veia porta: revisão de literatura e relato de caso

“…A TVPo foi descrita, pela primeira vez, por Balfour e Stweart [4] em 1869, sendo considerada a causa principal de Hipertensão Portal extra-hepática em doentes com fígado normal, no ocidente [5] . As etiologias da formação do coágulo podem ser divididas em quatro grupos: Lesão direta na veia porta, malformação congênita do sistema vascular com acometimento do sistema porta, fatores indiretos que influenciem na formação do trombo de veia porta e causas idiopáticas [1] .…”

“…Esses podem ser os primeiros sinais da obstrução. Mais tardiamente, biliopatia portal, o hiperesplenismo e sequestro de células imunológicas pelo baço podem se manifestar [1] .…”