PS66. Surgical and Endovascular Treatment of Severe Complications Secondary to Prehepatic Portal Hypertension: Experience of Forty-one Cases

Abstract

Prehepatice portal vein obstruction is an important cause of non-cirrhotic portal hypertension. The major complications of prehepatic portal hypertension (PPH) include bleeding esophagogastric varices, hypersplenism, and bowel ischemia. The aim of this article is to discuss the outcomes of surgical and endovascular treatment for the complications from PPH. From January 2000 to May 2009, 41 patients with PPH were treated with open surgery or catheter-directed thrombolysis. Twenty-nine were male and 12 were female. The median age was 20 years (2 to 54 years). Thirty-nine patients presented with hypersplenism; 37 had history of gastrointestinal bleeding; 4 patients complained of new onset of abdominal pain. Portosystemic shunt was performed in 34 patients, including 23 mesocaval, 8 splenorenal, 2 paraumblilical-jugular, and 1 portocaval shunt. Esophagogastric devascularization was performed in 3. Four patients with acute portal vein thrombosis were treated with catheter-directed thrombolysis. Mean follow up was 23.4 months (2 to 60 months). In the 34 patients undergoing portosystemic shunt, no one had recurrent bleeding. All the 3 patients with esophagogastric devascularization sustained recurrent variceal bleeding at 8, 13, and 24 months postoperatively. One of them died, and the other 2 were converted to mesocaval shunt. Of the 4 patients undergoing thrombolysis, 3 survived without complication; 1 died due to small bowel infarction secondary to recurrent portal and mesenteric vein thrombosis 40 days later. The 30-day mortality was zero in this group. Portosystemic shunt is a safe and effective treatment for bleeding esophagogastric varices and severe hypersplenism secondary to PPH. It is more reliable than esophagogastric devascularization. Endovascular catheter-directed thrombolysis is an alternative treatment for acute portal and/or mesenteric venous thrombosis; however, clinical investigation in a large group of patients is needed.