Surgical Management of Bleeding Gastroesophageal Varices in Children

Abstract

The management of portal hypertension in children presents technical and diagnostic problems not encountered in adults. In addition to cirrhosis and portal vein thrombosis a multiplicity of congenital diseases which may elevate portal pressure must be considered in the differential diagnosis. The diminutive caliber of the splanchnic vessels in children predisposes to a higher incidence of shunt failure in this age group. With the introduction of the mesocaval shunt by Marion¹ and Clatworthy,² portal decompression may now be accomplished in smaller children. The early and long-term prognosis for children with portal hypertension needs clarification. During the past eight years 23 children have undergone 29 operative procedures at the University of Michigan Medical Center to arrest bleeding from esophageal varices. Portal hypertension was secondary to portal vein obstruction in 13 cases and was caused by a variety of acquired and congenital diseases in the remainder. A multiplicity of operative