P1236 : Impact of high portal pressure on renal hemodynamics in children with portal hypertension

Abstract

Background and Aims: Hemorrhage from gastroesophageal varices in children with prehepatic portal hypertension is best controlled by various types of portosystemic shunt, but long-term follow up of children who have had splenorenal shunt surgery due to portal hypertension gave evidence for assuming the risk of renal venous hypertension (RVH). The purpose of this study was to investigate the impact of portosystemic shunt surgery on renal blood Methods: The results of 170 portosystemic shunt operations were followed from 2005 to 2014. 12 patients applied side to side splenorenal shunt, 12 children assessed the distal splenorenal shunt (DSRSh), 82 had central splenorenal shunt (CSRSh) with splenectomy. 44 iliacomesenterial anastomosis (IMA) and in 20 cases performed mesocaval anastomosis (MCA). Patients had a standard pre and postoperative work up including gastrointestinal endoscopy, Doppler ultrasonography (US), angiography, multislice computed tomography and MR imaging. Results: On Doppler US at early and late postoperative periods PI and RI of left renal artery remained at high numbers (PI = 1.48±0.17 and RI = 0.72±0.19, p ≤ 0.05 respectively) after the CSRSh with splenectomy. After DSRSh, these signs haven’t been detected. 11 (13.4%) patients after CSRSh on Doppler US revealed signs of impeded venous outflow on the left renal vein (LRV). 8 patients after IMA on US Doppler and CT and MRI angiography revealed dilated left testicular and ovarian veins (Figure 1), with retrograde blood flow in them, which clinically manifested as left flank pain, macroand microhematuria, varicocele and ovaricocele Conclusions: Portosystemic shunt surgery is highly effective treatment for children with prehepatic portal hypertension. But study shows that total shunts such as central splenorenal shunt with splenectomy and iliacomesenterial anastomosis more negatively effect on hemodynamics of left kidney. Shunting the large amounts of blood from a system of high pressure to a low manifests as clinical signs of renal venous hypertension.