Morphology of portal venous system in portal angiography of children with extrahepatic portal venous obstruction

Abstract

Objective \nTo explore the findings of portal angiography in children with extrahepatic portal hypertension and factors associated with morphology of portal venous system. \n \n \nMethods \nFrom February 2008 to October 2017, 107 patients (62 boys and 45 girls) with upper gastrointestinal bleeding or splenomegaly and hypersplenism were admitted. Cavernous transformation of portal vein was diagnosed by ultrasound and computed tomography (CT), The procedures were Rex shunt (n=99), Warren shunt (n=7) and laparoscopic splenic vessel ligation (n=1). Intraoperative superior mesenteric venography was employed for determining the morphology of portal venous system. According to the morphology of portal vein, they were divided into groups with and without a visible gastric coronary vein; groups with and without a visible splenic vein; group with appearance of cotton mass and group with visible collateral veins in portal cavernoma; groups with and without a decent visible intrahepatic portal vein. The preoperative and postoperative portal pressure, preoperative incidence of esophageal varices, time of onset, incidence of postoperative rebleeding, preoperative and postoperative splenic sizes and operative age were compared among the groups. The proportion of children undergoing gastroportal bypass was compared. And the correlations between appearance of cavernous transformation of portal vein and conditions of coronary vein, splenic vein and intrahepatic portal vein were analyzed. \n \n \nResults \nThe average follow-up duration was 48.1(3-120) months. The preoperative incidence of esophageal varices, time of onset, postoperative splenic size and operative age were significantly lower in the group with appearance of cotton mass than those of the group with visible collateral veins (P<0.05). The incidence of preoperative esophageal varices in the group with visible gastric coronary vein was significantly higher than that in the group without visible gastric coronary vein. A significant correlation existed between visible coronary vein and esophageal varices (P=0.002). Time of onset, preoperative & postoperative splenic lengths and operative age were significantly lower in the group with a decent visible intrahepatic portal vein than those in the group without a good visible intrahepatic portal vein (P<0.05). A significant correlation existed between morphology of portal cavernoma, appearances of gastric coronary vein and intrahepatic portal vein (P<0.05). Visible gastric coronary vein was significantly correlated with gastroportal shunt (P=0.000). And the group with a visible gastric coronary vein had a higher ratio of gastroportal shunt. \n \n \nConclusions \nAs an early stage of morphology in cavernous transformation of portal vein, appearance of cotton mass occurs frequently in children with smaller operative age, shorter time of onset and a lower incidence of esophageal varices. Children with a morphology of cotton mass usually have a better prognosis after Rex shunt. Extrahepatic portal hypertension should be treated timely after a definite diagnosis. Visible gastric coronary vein is an important indicator for gastroportal shunting. \n \n \nKey words: \nHypertension, portal;\xa0Child;\xa0Portography;\xa0Prognosis