Management and outcome of portal hypertension in children

Abstract 

Portal hypertension in children has significant morbidity and mortality. Although it is often recognized as a complication of cirrhotic liver disease, in this age group it can be the presentation of extrahepatic portal vein obstruction or congenital hepatic fibrosis. The specific management in each child is dependent on the aetiology. Gastrointestinal bleeding is potentially the most life-threatening complication in all cases. Newer effective medical management for variceal bleeding includes endoscopic band ligation, the use of octreotide and β-blockers and the insertion of a transjugular intrahepatic portosystemic shunt. Whilst the role of portosystemic shunting has reduced in extrahepatic portal venous obstruction, a newer surgical technique — the meso-portal shunt-has proved successful when indicated. Liver transplantation should be offered routinely to children with portal hypertension associated with decompensated liver disease.

Keywords: hypertension, portal, children, thrombosis, portal vein, gastrointestinal bleeding, ligation, portosystemic shunt, transjugular intrahepatic

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• f1 Correspondence to: PJM. E-mail: P.J.McGrogan@ncl.ac.uk