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

  • Noe Villanueva López Instituto Nacional de Pediatría
  • Karla Alejandra Santos Jasso Instituto Nacional de Pediatría
  • María Alicia Martínez Vega Hospital Ángeles del Pedregal
  • Francisco Antonio Medina Vega Instituto Nacional de Pediatría
Palabras clave: iliac-mesenteric-caval shunting, portal hypertension,

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.

Biografía del autor/a

Noe Villanueva López, Instituto Nacional de Pediatría
Fourth year resident, Pediatric Surgery
Karla Alejandra Santos Jasso, Instituto Nacional de Pediatría
Pediatric Surgeon. Staff Physician, Colorectal Surgery Clinic
María Alicia Martínez Vega, Hospital Ángeles del Pedregal
Neonatologist
Francisco Antonio Medina Vega, Instituto Nacional de Pediatría
Head of Pediatric Surgery Service

Citas

Bismuth H, Franco D, Alagille D. Portal Diversion for Portal

Hypertension in Children. Am Surg 1980;192:18-24.

Montano-Loza A, Meza-Junco J. Patogenesis de la hipertensión

portal. Rev Invest Clin 2005;57:596-607.

Antonio-Sandoval L, Yamamoto-Nagano A, Ortiz-Galvan RC, Diego-Perez J, Lorenzo-Hernandez A. Ventajas de la Derivación Esplenorrenal Distal vs otras derivaciones portosistemicas en pacientes pediátricos con Hipertensión Portal e Hiperesplenismo en un Hospital de Tercer Nivel de Atención. Rev Mex de Cir Ped 2008;15:106-13.

Shun A, Delaney DP, Martin HCO, Henry GM, Stephen M. Portosystemic Shunting for Paediatric Portal Hypertension. J Pediat Surg 1997;32:489-93.

Karrer J, Portal hypertension. Semin Pediatr Surg 1992;1:134-44.

Sahni P, Pande GK, Nundy S. Extrahepatic portal vein obstruction.

Br J Surg 1990;77:1201-2.

Terblanche J, Burroughs A, Kenneth EF. Controversies in the management of bleeding esophageal varices. N Engl J Med 1989;320:1393-8.

Santi P, Marion P. Techniques des derivations porto-caves. Semin Hop Paris 1953;29:2758-67.

Clatworthy H. A new type of portal to systemic venous

shunt for portal hypertension. Arch Surg 1955;71:588.

Clatworthy H, Boles T. Extrahepatic portal bed block in children:

pathogenesis and treatment. Ann Surg 1959;150:371-83.

Vargas-Gomez MA, Gonzalez-Castillo AD, Ramirez-Mayans JA, Mora-Tiscareno MA, Martinez-Sosa MC. Evaluación de la derivación mesentérico-iliaca y esplenorrenal en niños con hipertensión porta prehepática. Rev Mex Cir Ped 1994;1:59-70.

Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children II. Results of surgical portosystemic shunts. J Pediatr 1983;103:703-07.

Dasgupta R, Roberts E, Superina RA, Kim PC. Effectiveness of Rex shunt in the treatment of portal hypertension. J Pediat Surg 2006;41:108-12.

Chen H, Ping W, Yang P, Yan JQ, Li QY, Ma D, et al. Long Term results of small-diameter proximal splenorenal venous shunt: a retrospective study. World J Gastroenterol 2011;17:3453-58.

Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG. The management of portal hypertension: Rational basis, available treatments and future options. J Hepatol 2008;48:68-92.

Gugig R, Rosenthal P. Management of Portal Hypertension in children. Gastroenterol Rep 2011;13:1176-84.

Botha JF, Campos BD, Grant WJ, Horslen SP, Sudan DL, Shaw BW, et al Portosystemic Shunts in Children: A 15-Year Experience. J Am Coll Surg 2004;2:179-85.

Amico GD, De Franchis R, Cooperative Study Group. Upper Digestive Bleeding in Cirrhosis. Post–therapeutic Outcome and Prognostic Indicators. J Hepat 2003;38:599-612.

De Franchis R. Evolving Consensus in Portal Hypertension. Report of the Baveno IV Consensus Workshop on methodology

of diagnosis and therapy in portal hypertension. J Hepatol 2005;43:167-76.

Publicado
2014-07-09
Cómo citar
Villanueva López, N., Santos Jasso, K., Martínez Vega, M., & Medina Vega, F. (2014). Iliac-mesenteric-caval shunting in patients under two years of age. Case reports and review of the literature. Acta Pediátrica De México, 35(2), 117-122. https://doi.org/10.18233/APM35No2pp117-122
Sección
Caso clínico de interés especial