The surgical care of infants and children with portal hypertension has been reported infrequently. It was our desire to add our experience to that already reported and to consolidate what appears to us to be the basic problems facing the surgeon in the diagnosis and care of these children. PATHOGENESIS The classification of Whipple22 with slight modification serves equally well in children as in adults. I. Prehepatic A. Obstruction of inferior vena cava—congenital II. Hepatic A. Portal cirrhosis B. Thrombosis of hepatic veins (Chiari's syndrome) III. Posthepatic A. Congenital 1. Cavernomatous transformation of portal vein 2. Congenital stricture and obliteration of portal vein B. Acquired thrombosis of portal vein or its tributaries 1. Trauma 2. Infection 3. Idiopathic or spontaneous origin The posthepatic cases are the most distressing to the surgeon, and, although from a clinical standpoint they can be differentiated into congenital and acquired, they are too