Rex shunt in pediatric prehepatic portal hypertension: a clinical analysis of 5 cases

Abstract

Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH). Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed. There were three boys and two girls, with age ranging from 50 to 95.5 months [(75.8±1.9) months]. They all suffered from recurrent upper gastrointestinal (GI) blee-ding. Their red blood cell (RBC), white blood cell (WBC) and platelet (PLT) counts were decreased, but laboratory findings revealed no liver dysfunction. Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly. The mean splenic length was (42.8±8.2) cm. Indirect portal venography revealed patent left portal vein. All patients underwent Rex shunt and were followed up for 3~7 months. Results The mean duration of operation was (566.0±39.7) min. Intraoperative bleeding varied from 10 to 50 ml. The portal pressure significantly decreased after surgery from [(25.6±1.5) mmHg, 1 mmHg=0.133 kPa] preoperatively to (19.2±3.3) mmHg postoperatively (P<0.05). Portal venography indicated patent left portal vein after the Rex shunt. The postoperative course was uneventful in the five patients with a mean hospital stay of (26±9.3) days. There was no further GI bleeding. The RBC, WBC and PLT counts increased. Ultrasound indicated patent anastomotic stomas and decreased splenic size. Conclusion A Rex shunt in treating patients with PHPH is safe, feasible and efficacious. Key words: Rex shunt; Prehepatic portal hypertension; Cavernous transformation of portal vein; Children; Superior mesenteric vein; Left branch of portal vein