Non‐conventional portosystemic shunts in children with extrahepatic portal vein obstruction

D'Cruz, Ashley; Kamath, Patrick S.; Ramachandra, Chrishan J A; Jalihal, Anand

doi:10.1111/j.1442-200x.1995.tb03678.x

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…When the thrombus extends along the portosplenic axis, the chief route of decompression of the fundal gastric varices the splenic vein, is blocked; splenorenal shunts are not possible and a shunt with a superior mesenteric vein or its branch, even if patent, will not achieve decompression of gastric varices. Unorthodox shunts though occasionally successful [12] have a high failure rate [13]. Even if the shunt remains patent, adequate decompression through the small collateral does not take place [12], as was seen in one patient in this series.…”

Section: Discussionmentioning

confidence: 62%

“…Unorthodox shunts though occasionally successful [12] have a high failure rate [13]. Even if the shunt remains patent, adequate decompression through the small collateral does not take place [12], as was seen in one patient in this series.…”

Section: Discussionmentioning

confidence: 62%

“…One patient was lost to follow up after the first check endoscopy, one bleed free and awaiting his first check endoscopy. The remaining 12 have followed up over a mean of 38.4 months SD 22.6 months (range 17-90 months). There has been no late mortality.…”

Section: Resultsmentioning

confidence: 99%

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Results of a Modified Sugiura′s Devascularisation in theManagement of “Unshuntable” Portal Hypertension

Shah

Nagral²,

Mathur³

1998

HPB Surgery

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The results of a modified Sugiura devascularisation procedure were assessed in 14 patients with thrombosis of the portal and splenic vein requiring surgery for variceal hemorrhage, with no vein suitable for orthodox shunt surgery. The venous anatomy was determined by ultrasonography with Doppler studies and portovenography. Liver biochemistry as well as liver architecture on histopathology was normal in all. The surgery was elective in 9 cases for documented bleed from diffuse fundal gastric varices (FGV) and emergency in 5 cases, 3 having bleeding FGV and 2 for failure of emergency esophageal variceal sclerotherapy. All were subjected to a transabdominal extensive devascularisation of the upper two third of the stomach and lower 7–10cm of the esophagus. Stapled esophageal transection (n=11) or esophageal variceal under-running (n=1) was performed in all with esophageal varices. FGV were underrun. Follow up endoscopies were done six monthly. There were 9 males and 5 females with a mean age of 17.2 years (SD 12.8). There was no operative mortality. Acute variceal bleeding was controlled in all patients. Over a mean follow up of 38 months, all but one remain free of recurrent bleeding. We conclude that a modified Sugiura devascularisation procedure is effective in the immediate and medium term control of variceal bleeding in patients with “unshuntable” portal hypertension.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 62%

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Results of a Modified Sugiura′s Devascularisation in theManagement of “Unshuntable” Portal Hypertension

Shah

Nagral²,

Mathur³

1998

HPB Surgery

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“…The non-selective portosystemic shunts, such as mesocaval, portocaval or central splenorenal shunt, adequately decompress the portal circulation, but because they are considered major surgical procedures, they are not commonly used nowadays. Also, non-conventional portosystemic shunts using large collateral vessels may be performed in patients with EPVO, for example, children with extensive thrombosis of the portal venous system [ 90 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Updates in the pathogenesis, diagnosis and management of ectopic varices

2008

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Ectopic varices (EcV) comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. No large series or randomizedcontrolled trials address this subject, and therefore its management is based on available expertise and facilities, and may require a multidisciplinary team approach. EcV are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1-5% of all variceal bleeding. EcV develop secondary to portal hypertension (PHT), surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial in origin. Bleeding EcV may present with anaemia, shock, haematemesis, melaena or haematochezia and should be considered in patients with PHT and gastrointestinal bleeding or anaemia of obscure origin. EcV may be discovered during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, colour Doppler-flow imaging, laparotomy, laparoscopy and occasionally during autopsy. Patients with suspected EcV bleeding need immediate assessment, resuscitation, haemodynamic stabilization and referral to specialist centres. Management of EcV involves medical, endoscopic, interventional radiological and surgical modalities depending on patients' condition, site of varices, available expertise and patients' subsequent management plan.

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“…In case of extensive thrombosis of the portal venous system, nonconventional portosystemic shunts using large collateral vessels may be performed. 30 There are no data available regarding the use of ␤ adrenergicblockers or nitrates in the long-term management of patients with ectopic varices. A meta-analysis of randomized, controlled trials comparing a nonselective ␤-blockade versus placebo showed the efficacy of ␤-blocker therapy for secondary prophylaxis of bleeding from esophagogastric varices.…”

Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

Management of ectopic varices

1998

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The term ''ectopic varices'' is sometimes reserved for abnormally dilated veins associated with gastrointestinal mucosa and, therefore, with the potential for gastrointestinal hemorrhage. However, the term has also been used loosely to describe portosystemic collateral veins in the abdominal wall and retroperitoneum. The distinction between ''ectopic varices'' and collaterals that are commonly found on the abdominal wall and retroperitoneum of patients with portal hypertension is one of semantics. Thus, ectopic varices may be best defined as large portosystemic venous collaterals occurring anywhere in the abdomen except in the cardioesophageal region.Ectopic varices are an unusual cause of gastrointestinal hemorrhage, but account for up to 5% of all variceal bleeding. 1 The clinician caring for patients with gastrointestinal bleeding must be aware of this entity, because diagnosis and management of ectopic varices differ from that of esophagogastric varices. Furthermore, the prognosis from bleeding ectopic varices may be poor, with one study quoting 40% mortality at initial bleed from duodenal varices. 2 The literature on this subject consists mainly of small series and case reports with no randomized trials of therapeutic modalities. However, a review of the literature does provide sufficient information from which rational management decisions can be made. PREVALENCEEctopic varices account for between 1% and 5% of all variceal bleeding. 1,3 Ectopic varices are a relatively common finding at endoscopy in patients with portal hypertension. The prevalence seems to be related to the cause of the portal hypertension and the technique used to show the varices. In patients with intrahepatic portal hypertension, duodenal varices are seen in 40% of patients undergoing angiography, 3 whereas anorectal varices have been reported in between 10% and 40% of cirrhotic patients undergoing colonoscopy. 4,5 It is important to differentiate anal varices from hemorrhoids: Anal varices collapse with digital pressure, whereas hemorrhoids do not. 4 In patients with portal hypertension caused by obstruction of the portal or splenic veins, duodenal varices are more prevalent than in patients with intrahepatic portal hypertension. The prevalence is higher if angiography is used to show varices. In fact, most patients with portal or splenic vein thrombosis are likely to have duodenal varices shown on angiography. 6,7 The majority of patients with duodenal varices visualized on endoscopy have extrahepatic portal hypertension. In contrast to duodenal varices, it appears that most cases of varices in other portions of the small intestine and colonic varices are seen in patients with intrahepatic portal hypertension who have previously undergone abdominal surgery. 6 In the west, because the prevalence of extrahepatic portal hypertension is low, most bleeding from ectopic varices is usually associated with intrahepatic portal hypertension. 6,8 Stomal varices are a particularly common cause of ectopic varices and occur in patients with intrah...

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Non‐conventional portosystemic shunts in children with extrahepatic portal vein obstruction

Cited by 10 publications

References 8 publications

Results of a Modified Sugiura′s Devascularisation in theManagement of “Unshuntable” Portal Hypertension

Results of a Modified Sugiura′s Devascularisation in theManagement of “Unshuntable” Portal Hypertension

Updates in the pathogenesis, diagnosis and management of ectopic varices

Management of ectopic varices

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