EXTRAHEPATIC PORTAL HYPERTENSION: THE CLINICAL EVALUATION, INVESTIGATION AND RESULTS OF TREATMENT OF 28 PATIENTS

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Abstract
Summary: The clinical picture of 28 patients with extrahepatic portal hypertension who presented before 19 years of age is described. There was a high incidence of infection in early life. Gastro‐intestinal bleeding was precipitated by salicylates, fragments of bone and pregnancy.Splenoportography showed that two patients had developed spontaneous hæmodynamically significant portacaval shunts.The results of surgical treatment were satisfactory, but not good enough to make surgery the management of choice. Conservative non‐operative management, with stress on the avoidance of salicylates and traumatic dietary intake, has been satisfactory for some patients. The spontaneous development of hæmodynamically significant portal‐systemic shunts, not through œsophageal varices, and the small size of the splenic vein in children provide additional reasons for avoiding surgical treatment except in emergencies to control bleeding.The choice of surgical treatment lies between spleno‐renal anastomosis and interruption of the gastro‐œsophageal venous anastomoses.

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