Iliac-mesenteric-caval shunting in patients under two years of age. Case reports and review of the literature

Resumen

Introduction: in treating portal hypertension in pediatric patients, some form of portosystemic shunting is indicated, a surgical procedure rarely used in patients under two years of age due to the infrequency of the condition in that age group and the increase in complications.

Objective: discuss the experience and results of this procedure in patients under two years of age attended at the Hepatobiliopancreatic Surgery clinic of the General Surgery Service at Instituto Nacional de Pediatria.

Discussion: the causes of portal hypertension at pediatric age are varied. Of extrahepatic manifestations, the most common is portal cavernomatous degeneration. Children under two years of age with portal hypertension have severe symptoms such as recurrent or anemia-causing digestive bleeding; others have signs of hypersplenism. In many cases medical treatment has no usefulness and surgical intervention, such as portosystemic shunting, is required to reduce the size of varices and prevent life-threatening bleeding.

Conclusion: iliac-mesenteric-caval shunting in patients under two years of age is a feasible alternative which improves the patient’s clinical status, reducing the risk of bleeding; however, long-term studies are needed to observe such patients’ evolution.