Meso-Rex bypass in a 7-month-old child with prehepatic portal hypertension

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Abstract

BACKGROUND: The prehepatic form of portal hypertension is the most common cause of portal hypertension in children. Nowadays mesoportal shunting is the most optimal therapy for such pathology. In the world literature, there are only few publications describing application of such surgical technique in children of the first year of life.

CLINICAL CASE DESCRIPTION: The article describes a case of a 7-month old child with prehepatic portal hypertension who had mesoportal bypass surgery. A month before the surgery, the child had an episode of gastrointestinal bleeding which was treated conservatively. Additional diagnostics before surgery included liver and spleen ultrasound examination, transarterial mesenteric portography, and esophagogastroduodenoscopy. The child was discharged home on the 6th postoperative day. For three months after the surgery, he received antiplatelet therapy and proton pump inhibitors. In 3-months, follow-up ultrasound showed satisfactory blood flow through the shunt. Patient’s weight gain had also a positive trend.

CONCLUSION: Mesoportal bypass surgery is technically achievable in children of the first year of life. In our opinion, patient’s age has a positive impact on creating a functioning mesoportal shunt: the younger the patient, the greater the likelihood of favorable outcome.

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About the authors

Aleksandr S. Zadvernyuk

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Author for correspondence.
Email: drsasha81@yandex.ru
ORCID iD: 0000-0003-4379-8051
SPIN-code: 8803-6595

MD, Cand. Sci. (Medicine)

Россия, Ostrovityanova street, 1, buil. 7, Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow

Nadezhda V. Kulikova

Filatov N.F. Children's City Hospital

Email: dr.kulikovan.v@gmail.com
ORCID iD: 0000-0003-0834-2630
SPIN-code: 4687-1558

MD, Cand. Sci. (Medicine)

Россия, 15 Sadovaya-Kudrinskaya street, 123001 Moscow

Vera I. Nurik

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: vera.nurik@mail.ru
ORCID iD: 0009-0002-6025-1357
SPIN-code: 1431-2990

MD, Cand. Sci. (Medicine)

Россия, Ostrovityanova street, 1, buil. 7, Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow

Aleksander Yu. Razumovskiy

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: 1595105@mail.ru
ORCID iD: 0000-0002-9497-4070
SPIN-code: 3600-4701

MD, Dr. Sci. (Medicine), Professor

Россия, Ostrovityanova street, 1, buil. 7, Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow

Natalia A. Knyazeva

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

Email: nata-knya@yandex.ru
ORCID iD: 0009-0004-0771-6922
SPIN-code: 8851-7247
Россия, 15 Sadovaya-Kudrinskaya street, 123001 Moscow

References

  1. McKiernan P, Abdel-Hady M. Advances in the management of childhood portal hypertension. Expert Rev Gastroenterol Hepatol. 2015;9(5):575–583. doi: 10.1586/17474124.2015.993610
  2. Alberti D, Colusso M, Cheli M, et al. Results of a stepwise approach to extrahepatic portal vein obstruction in children. J Pediatr Gastroenterol Nutr. 2013;57(5):619–626. doi: 10.1097/MPG.0b013e31829fad46
  3. Maddrey WC, Basu Mallik HC, Iber FL. Extrahepatic portal obstruction of the portal venous system. Surg Gynaecol Obstetr. 1968;127(5):989–998.
  4. Pietrobattista A, Luciani M, Abraldes JG, et al. Extrahepatic portal vein thrombosis in children and adolescents: Influence of genetic thrombophilic disorders. World J Gastroenterol. 2010;16(48):6123–6127. doi: 10.3748/wjg.v16.i48.6123
  5. Rosendaal FR. Thrombosis in the young: Epidemiology and risk factors. A focus on venous thrombosis. Thromb Haemost. 1997;78(1):1–6. doi: 10.1055/s-0038-1657492
  6. Kim JH, Lee YS, Kim SH, et al. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology. 2001;219(3):645–650. doi: 10.1148/radiology.219.3.r01jn17645
  7. Boo NY, Wong NC, Zulkifli SS, Lye MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health. 1999;35(5):460–465. doi: 10.1046/j.1440-1754.1999.355392.x
  8. Giouleme O, Theocharidou E. Management of portal hypertension in children with portal vein thrombosis. J Pediatric Gastroenterol Nutr. 2013;57(4):419–425. doi: 10.1097/MPG.0b013e3182a1cd7f
  9. De Ville de Goyet J, D’Ambrosio G, Grimaldi C. Surgical management of portal hypertension in children. Semin Pediatr Surg. 2012;21(3):219–232. doi: 10.1053/j.sempedsurg.2012.05.005
  10. Facciuto ME, Rodriguez-Davalos MI, Singh MK, et al. Recanalized umbilical vein conduit for meso-Rex bypass in extrahepatic portal vein obstruction. Surgery. 2009;145(4):406–410. doi: 10.1016/j.surg.2008.12.004
  11. Superina R, Shneider B, Emre S, et al. Surgical guidelines for the management of extra-hepatic portal vein obstruction. Pediatr Transplant. 2006;10(8):908–913. doi: 10.1111/j.1399-3046.2006.00598.x
  12. Yamoto M, Chusilp S, Alganabi M, Sayed BA, Pierro A. MesoRex bypass versus portosystemic shunt for the management of extrahepatic portal vein obstruction in children: Systematic review and meta-analysis. Pediatr Surg Int. 2021;37(12):1699–1710. doi: 10.1007/s00383-021-04986-z
  13. Zhang J, Li L. Rex Shunt for Extra-Hepatic Portal Venous Obstruction in Children. Children (Basel). 2022;9(2):297. doi: 10.3390/children9020297
  14. Bellomo-Brandao MA, Morcillo AM, Hessel G, et al. Growth assessment in children with extra-hepatic portal vein obstruction and portal hypertension. Arq Gastroenterol. 2003;40(4):247–250. doi: 10.1590/s0004-28032003000400009
  15. Van der Plas SM, Hansen BE, de Boer JB, et al. Generic and disease specific health related quality of life in non-cirrhotic, cirrhotic and transplanted liver patients: A cross-sectional study. BMC Gastroenterol. 2003;(3):33. doi: 10.1186/1471-230X-3-33
  16. Goel A, Yadav S, Saraswat V, et al. Cerebral oedema in minimal hepatic encephalopathy due to extrahepatic portal venous obstruction. Liver Int. 2010;30(8):1143–1151. doi: 10.1111/j.1478-3231.2010.02289.x
  17. Lautz TB, Sundaram SS, Whitington PF, et al. Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass. J Pediatr Surg. 2009;44(11):2067–2070. doi: 10.1016/j.jpedsurg.2009.05.016
  18. Mack CL, Zelko FA, Lokar J, et al. Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability. Pediatrics. 2006;117(3):e405–412. doi: 10.1542/peds.2005-1177
  19. Stringer MD. Improved body mass index after mesenterico-portal bypass. Pediatr Surg Int. 2007;23(6):539–543. doi: 10.1007/s00383-007-1920-z
  20. Chiu B, Superina RA. Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass. J Pediatr Surg. 2006;41(6):1177–1179. doi: 10.1016/j.jpedsurg.2006.01.075
  21. Mack CL, Superina RA, Whitington PF. Surgical restoration of portal flow corrects procoagulant and anticoagulant deficiencies associated with extrahepatic portal hypertension. J Pediatr. 2003;142(2):197–199. doi: 10.1067/mpd.2003.93
  22. Sharif K, McKiernan P, de Ville de Goyet J, et al. Mesoportal bypass for extrahepatic portal vein obstruction in children: Close to a cure for most! J Pediatr Surg. 2010;45(1):272–276. doi: 10.1016/j.jpedsurg.2009.08.019
  23. De Ville de Goyet J, Alberti D, Clapuyt P, et al. Direct bypassing of extrahepatic portal venous obstruction in children: A new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg. 1998;33(4):597–560. doi: 10.1016/s0022-3468(98)90324-4
  24. Bertocchini A, Falappa P, Grimaldi C, et al. Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance. J Pediatr Surg. 2014;49(8):1268-1275. doi: 10.1016/j.jpedsurg.2013.10.029

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Preoperative transarterial mesentericoportography.

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3. Fig. 2. Intraoperative picture.

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4. Fig. 3. Child in 3 months after the surgery.

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Copyright (c) 2024 Zadvernyuk A.S., Kulikova N.V., Nurik V.I., Razumovskiy A.Y., Knyazeva N.A.

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