Mesoportal shunt reconstruction in a 10-year-old child with extrahepatic portal hypertension

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Abstract

Purpose. The basic management task of children with extrahepatic portal hypertension (EHPH) is to prevent bleeding from intestinal and gastric protuberant varicosities. Materials and methods. Meso-portal shunting doesn’t only prevent bleedings from varicose veins, but also restores normal anatomical and physiological relations within the basin of the portal vein. The Clinical Hospital No. 13 has the largest experience of treating patients with EHPH. From 1989 to 2017 we observed 789 patients with portal hypertension aged 2.5 months to 17 years. 23.5% of them included children under 3 years old. Since 2000, meso-portal shunting was done in 261 children. 239 (91.6%) patients had an excellent result such as reduction of varicose veins and restored portal hepatic perfusion. Discussion. A clinical case of a 9-year-old child diagnosed with extrahepatic portal hypertension was presented. The girl underwent meso-portal shunting. However, no reduction of intestinal varicose veins was presented during the post-operative period. Meso-portal shunting stenosis was found during an angiographic study. The child had another operation; stenosis of meso-portal shunt was diagnosed, a narrowed section was resected with subsequent restoration of vascular insertion patency. During the postoperative period, varicose veins disappeared completely. Conclusion. The presented clinical example displays modern surgical possibilities of portal hypertension in children even in such complicated cases as stenosis of vascular venous anastomosis occurring following MPS approximately in 10% of cases.

About the authors

A. Yu. Razumovsky

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov; Russian National Research Medical University named after N. I. Pirogov

Email: fake@neicon.ru
ORCID iD: 0000-0002-9497-4070

Alexander Yu. RAZUMOVSKIY - Dr. Sci. (Med), Professor, Corresponding member of the Russian Academy of Science, Head of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Thoracic Surgery of the Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

str. Ostrovityanova, 1, Moscow, 117997

Russian Federation

Z. B. Mitupov

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

Email: fake@neicon.ru

Zoricto B. MITUPOV - Dr. Sci. (Med), Professor of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Surgeon of the Department of Thoracic Surgery of the Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

str. Ostrovityanova, 1, Moscow, 117997

Russian Federation

A. B. Alkhasov

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

Email: fake@neicon.ru
ORCID iD: 0000-0003-3925-4991

Abdumanap B. ALKHASOV - Dr. Sci. (Med), Professor of the Department of Pediatric Surgery of Pirogov Russian National Medical Research University of the Ministry of Health of Russian Federation, Head of the Department of Thoracic Surgery of National Medical Research Center for Children’s Health of the Ministry of Health of Russian Federation

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

Russian Federation

I. E. Galibin

Children’s Municipal Clinical Hospital No. 13 named after N. F. Filatov

Email: fake@neicon.ru

Ilya Ye. GALIBIN - Head of the Department of Interventional Radiology

str. Sadovaya-Kudrinskaya, 15, Moscow, 103001

Russian Federation

E. V. Feoktistova

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

Email: fake@neicon.ru
ORCID iD: 0000-0003-2348-221X

Elena V. FEOKTISTOVA - Cand. Sci. (Med), Associate professor of the Department of Pediatric Surgery of Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Ultrasound Diagnostics of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russian Federation

str. Ostrovityanova, 1, Moscow, 117997

Russian Federation

V. E. Rachkov

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

Author for correspondence.
Email: vrachcov@mail.ru
ORCID iD: 0000-0002-1304-0592

Victor Е. RACHKOV - Dr. Sci. (Med), Chief researcher of the Institute of Clinical Surgery, Russian National Research Medical University named after N. I. Pirogov; Head of the Department of Pediatric Surgery of Clinical Hospital “Lapino”

Sadovaya-Kudrinskay str., 15, Moscow, 103001
phone: +7(916)696–89–14

Russian Federation

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Copyright (c) 2019 Razumovsky A.Y., Mitupov Z.B., Alkhasov A.B., Galibin I.E., Feoktistova E.V., Rachkov V.E.

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