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

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Supplementary files

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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.