Mesoportal shunt reconstruction in a 10-year-old child with extrahepatic portal hypertension

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Purpose. The basic management task of children with extrahepatic portal hypertension (EHPH) is to prevent bleeding from intestinal and gastric protuberant varicosities. Materials and methods. Meso-portal shunting doesn’t only prevent bleedings from varicose veins, but also restores normal anatomical and physiological relations within the basin of the portal vein. The Clinical Hospital No. 13 has the largest experience of treating patients with EHPH. From 1989 to 2017 we observed 789 patients with portal hypertension aged 2.5 months to 17 years. 23.5% of them included children under 3 years old. Since 2000, meso-portal shunting was done in 261 children. 239 (91.6%) patients had an excellent result such as reduction of varicose veins and restored portal hepatic perfusion. Discussion. A clinical case of a 9-year-old child diagnosed with extrahepatic portal hypertension was presented. The girl underwent meso-portal shunting. However, no reduction of intestinal varicose veins was presented during the post-operative period. Meso-portal shunting stenosis was found during an angiographic study. The child had another operation; stenosis of meso-portal shunt was diagnosed, a narrowed section was resected with subsequent restoration of vascular insertion patency. During the postoperative period, varicose veins disappeared completely. Conclusion. The presented clinical example displays modern surgical possibilities of portal hypertension in children even in such complicated cases as stenosis of vascular venous anastomosis occurring following MPS approximately in 10% of cases.

作者简介

A. Razumovsky

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov; Russian National Research Medical University named after N. I. Pirogov

Email: fake@neicon.ru
ORCID iD: 0000-0002-9497-4070

Alexander Yu. RAZUMOVSKIY - Dr. Sci. (Med), Professor, Corresponding member of the Russian Academy of Science, Head of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Thoracic Surgery of the Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

str. Ostrovityanova, 1, Moscow, 117997

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Z. Mitupov

Russian National Research Medical University named after N. I. Pirogov

Email: fake@neicon.ru

Zoricto B. MITUPOV - Dr. Sci. (Med), Professor of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Surgeon of the Department of Thoracic Surgery of the Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

str. Ostrovityanova, 1, Moscow, 117997

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A. Alkhasov

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

Email: fake@neicon.ru
ORCID iD: 0000-0003-3925-4991

Abdumanap B. ALKHASOV - Dr. Sci. (Med), Professor of the Department of Pediatric Surgery of Pirogov Russian National Medical Research University of the Ministry of Health of Russian Federation, Head of the Department of Thoracic Surgery of National Medical Research Center for Children’s Health of the Ministry of Health of Russian Federation

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

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I. Galibin

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

Email: fake@neicon.ru

Ilya Ye. GALIBIN - Head of the Department of Interventional Radiology

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

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E. Feoktistova

Russian National Research Medical University named after N. I. Pirogov

Email: fake@neicon.ru
ORCID iD: 0000-0003-2348-221X

Elena V. FEOKTISTOVA - Cand. Sci. (Med), Associate professor of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Ultrasound Diagnostics of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russian Federation

str. Ostrovityanova, 1, Moscow, 117997

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V. Rachkov

Russian National Research Medical University named after N. I. Pirogov

编辑信件的主要联系方式.
Email: vrachcov@mail.ru
ORCID iD: 0000-0002-1304-0592

Victor Е. RACHKOV - Dr. Sci. (Med), Chief researcher of the Institute of Clinical Surgery, Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Pediatric Surgery of Clinical Hospital “Lapino”

Sadovaya-Kudrinskay str., 15, Moscow, 103001
phone: +7(916)696–89–14

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参考

  1. Chiu B., Superina R. A. Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass. J. Pediatr. Surg. 2006;41(6):1177–9. doi: 10.1016/j.jpedsurg.2006.01.075
  2. De Ville de Goyet J., Lo Zupone C., Grimaldi C., D’Ambrosio G., Candusso M., Torre G. Meso-Rex bypass as an alternative technique for portal vein reconstruction at or after liver transplantation in children: review and perspectives. Pediatr. Transplant. 2013;17 (1):19–26. doi: 10.1111/j.1399–3046.2012.01784.x
  3. Im G. Y., Lubezky N., Facciuto M. E., Schiano T. D. Surgery in patients with portal hypertension: a preoperative checklist and strategies for attenuating risk. Clin. Liver Dis. 2014;18 (2):477–505
  4. Imanieh M. H., Dehghani S. M., Khoshkhui M., Malekpour A. Etiology of portal hypertension in children: a single center’s experiences. Middle East. J. Dig. Dis. 2012;4(4):206–10
  5. Леонтьев А. Ф., Сотникова О. Д., Марков Б. А., Дворяковский И. В. Портальное кровообращение у детей в норме и при внутрипеченочной портальной гипертензии. Детская хирургия. 2005;(6):27–30
  6. Giouleme O., Theocharidou E. Management of portal hypertension in children with portal vein thrombosis. J. Pediatr. Gastroenterol. Nutr. 2013;57(4):419–25. doi: 10.1097/MPG.0b013e3182a1cd7f
  7. Gu S., Chang S., Chu J., Xu M., Yan Z., Liu D. C. Spleno-adrenal shunt: a novel alternative for portosystemic decompression in children with portal vein cavernous transformation. J. Pediatr. Surg. 2012;47(12):2189–93. doi: 10.1016/j.jpedsurg.2012.09.007
  8. Разумовский А.Ю., Рачков В. Е., Феоктистова Е. В., Галибин И. Е. Портальная гипертензия у детей: современные аспекты портосистемного шунтирования. Хирургия. 2007; (9): 41–45
  9. Lautz T. B., Keys L. A., Melvin J. C., Ito J., Superina R. A. Advantages of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J. Am. Coll. Surg. 2013;216(1):83–9. doi: 10.1016/j.jamcollsurg.2012.09.013
  10. Lautz T. B., Kim S. T., Donaldson J. S., Superina R. A. Outcomes of percutaneous interventions for managing stenosis after mesoRex bypass for extrahepatic portal vein obstruction. J. Vasc. Interv. Radiol. 2012;23(3):377–83. doi: 10.1016/j.jvir.2011.11.030
  11. Superina R., Bambini D. A., Lokar J., Rigsby C., Whitington P. F. Correction of extrahepatic portal vein thrombosis by mesenteric to left portal vein bypass. Ann Surg. 2006;243(4):515–21. doi: 10.1097/01.sla.0000205827.73706.97
  12. Sharif K., Mckiernan P., De Ville de Goyet J. Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most! J. Pediatr. Surg. 2010;45(1):272–6. doi: 10.1016/j.jpedsurg.2009.08.019
  13. Fuchs J., Warmann S., Kardor R., Rosenthal H., Rodeck B., Ure B., Melter M. Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: a unique curative approach. J. Pediatr. Gastroenterol. Nutr. 2003;36(2):213–6. doi: 10.1097/00005176–200302000–00010
  14. Bhat R., Lautz T. B., Superina R. A., Liem R. Perioperative strategies and thrombophilia in children with extrahepatic portal vein obstruction undergoing the meso-rex bypass. J. Gastrointest. Surg. May 2013;17(5):949–55. doi: 10.1007/s11605–013–2155-z
  15. Guerin F., Bidault V., Gonzales E., Franchi-Abella S., De Lambert G., Branchereau S. Meso-Rex bypass for extrahepatic portal vein obstruction in children. Br. J. Surg. Nov 2013;100(12):1606–13. doi: 10.1002/bjs.9287
  16. Luoto T., Pakarinen M., Mattila I., Rintala R. Mesoportal bypass using a constructed saphenous vein graft for extrahepatic portal vein obstruction-technique, feasibility, and outcomes. J. Pediatr. Surg. Apr 2012;47(4):688–93. doi: 10.1016/j.jpedsurg.2011.10.065
  17. Area C., Kirsch D., Gowharji L. Interventional management of pediatric Rex shunt stenosis. Ochsner J. Spring 2017;17(1):6–8
  18. Yabuta M., Shibata T., Shibata T., Shinozuka K., Isoda H., Okamoto S., Uemoto S., Togashi K. Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute’s experience. J. VascInterv. Radiol. 2014;25(9):1406–12. doi: 10.1016/j.jvir.2014.03.034
  19. Zhang J. S., Li L., Cheng W. Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt? Pediatr. Surg. Int. 2018;34(5):521–7. doi: 10.1007/s00383–018–4246–0
  20. Разумовский А. Ю., Рачков В. Е. Хирургическое лечение портальной гипертензии у детей. Москва: МИА;2012;480с.
  21. Chin A.C, Thow F., Superina R. A. Previous portal hypertension surgery negatively affects results of mesenteric to left portal vein bypass. J. Pediatr. Surg. 2008;43(1):114–9. doi: 10.1016/j.jpedsurg.2007.09.032

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版权所有 © Razumovsky A.Y., Mitupov Z.B., Alkhasov A.B., Galibin I.E., Feoktistova E.V., Rachkov V.E., 2019

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