Abstract
One of the most important causes of portal hypertension among children is extrahepatic portal vein thrombosis (EHPVT). The most common risk factors for EHPVT are neonatal umbilical vein catheterization, transfusions, bacterial infections, dehydration, and thrombophilia. Our study aimed to describe the clinical manifestations, treatment, evolution, and risk factors of children with EHPVT. Methods: We analyzed retrospectively all children admitted and followed in our hospital with EHPVT between January 2011–December 2020. The diagnosis was made by ultrasound or contrast magnetic resonance imaging. We evaluated the onset symptoms, complications, therapeutic methods, and risk factors. Results: A total of 63 children, mean age 5.14 ± 4.90 (33 boys, 52.38%), were evaluated for EHPVT during the study period. The first symptoms were upper gastrointestinal bleeding (31 children, 49.21%) and splenomegaly (22 children, 34.92%). Thrombocytopenia was present in 44 children (69.84%). The most frequent risk factors were umbilical vein catheterization (46 children, 73.02%) and bacterial infections during the neonatal period (30 children, 47.62%). Protein C, protein S, antithrombin III levels were decreased in 44 of the 48 patients tested. In 42 of these cases, mutations for thrombophilia were tested, and 37 were positive. Upper digestive endoscopy was performed in all cases, revealing esophageal varices in 56 children (88.89%). All children with gastrointestinal bleeding received an octreotide infusion. In 26 children (41.27%), variceal ligation was performed, and in 5 children (7.94%), sclerotherapy. Porto-systemic shunt was performed in 11 children (17.46%), and Meso-Rex shunt was done in 4 children (6.35%). The evolution was favorable in 62 cases (98.41%). Only one child died secondary to severe sepsis. Conclusions: EHPVT is frequently diagnosed in the last period in our region due to the increased use of umbilical vein catheterization. Furthermore, genetic predisposition, neonatal bacterial infections, and prematurity certainly play an important role in this condition. A proactive ultrasound assessment of children with risk factors for EHPVT should be encouraged for early diagnosis and treatment.
Highlights
In children, portal hypertension (PHT) is defined as a pathological increase of the pressure in the portal system, with a pressure gradient between the portal vein and inferior vena cava greater than 5 mmHg [1]
In 32 patients (50.79%), the onset of disease was without bleeding: splenomegaly was the first sign in 22 children (34.92%), and in 10 children (15.87%), the diagnostic was established by ultrasound examination
extrahepatic portal vein thrombosis (EHPVT) is a common cause of severe upper gastrointestinal bleeding or splenomegaly in children from the Nord-Western of Romania
Summary
Portal hypertension (PHT) is defined as a pathological increase of the pressure in the portal system, with a pressure gradient between the portal vein and inferior vena cava greater than 5 mmHg [1]. As one of the causes of PHT in children, extrahepatic portal vein thrombosis (EHPVT) is a rare disorder, with an incidence of 1 in. These symptoms are absent during the neonatal period and appear later in childhood For this reason, the diagnosis is established more frequently in older children [2]. The causes of EHPVT in children are not entirely known, but several factors that predispose to this pathology are described [3]. These are classified into three categories: local factors that can cause injury to the portal vein (abdominal infections, abdominal surgery, umbilical catheter), general factors (procoagulant status), and, less often, vascular malformation.
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