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Semin Liver Dis 2002; 22(1): 043-058
DOI: 10.1055/s-2002-23206
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Extrahepatic Portal Vein Obstruction

Shiv K. Sarin, Shri Ram Agarwal
  • Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
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Publication History

Publication Date:
27 March 2002 (online)

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ABSTRACT

Extrahepatic portal vein obstruction (EHPVO) is an important cause of noncirrhotic portal hypertension, especially in Third World countries. The etiology and clinical presentation are different in children and adults. The portal vein is transformed into a cavernoma, resulting in portal hypertension and oesophagogastic varices. In addition, extensive collateral circulation develops, involving paracholecystic, paracholedochal and pancreaticoduodenal veins resulting in formation of ectopic varices, and portal biliopathy. Besides variceal bleeding, which is the commonest presentation, patients may have symptomatic portal biliopathy, hypersplenism, and growth retardation. Although the liver may appear normal, functional compromise develops in the long term. Variceal bleeding in EHPVO can be successfully managed by endoscopic obliteration of varices, which has low morbidity but requires repeated visits, or by portosystemic shunt surgery, which provides good control of bleeding, possibly helps growth retardation, hypersplenism, and protects against future development of portal biliopathy but is associated with surgical mortality and is sometimes not feasible due to nonavailability of a satisfactory vessel.

KEYWORD

Portal vein thrombosis - portal hypertension - noncirrhotic portal hypertension - variceal bleeding

REFERENCES

  • 1 Anand C S, Tandon B N, Nundy S. The causes, management and outcome of upper gastrointestinal hemorrhage in an Indian hospital.  Br J Surg . 1983;  70 209-211
    PubMedGoogle Scholar
  • 2 Alvarez F, Bernard O, Brunelle F. Portal obstruction in children. I. Clinical investigations and hemorrhage risk.  J Pediatr . 1983;  103 696-702
    PubMedGoogle Scholar
  • 3 Mitra S K, Kumar V, Dutta D V. Extrahepatic portal hypertension: a review of 70 cases.  J Pediatr Surg . 1978;  13 51-54
    CrossrefPubMedGoogle Scholar
  • 4 Webb L J, Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction.  Q J Med . 1979;  192 627-639
    PubMedGoogle Scholar
  • 5 Rosch J, Dotter C T. Extrahepatic portal obstruction in childhood and its angiographic diagnosis.  Am J Radiol . 1981;  112 143-149
    PubMedGoogle Scholar
  • 6 Shaldon S, Sherlock S. Obstruction to the extrahepatic portal system in childhood.  Lancet . 1962;  1 63-67
    PubMedGoogle Scholar
  • 7 Gibson J B, Johnson G W, Rodgers H W. Extrahepatic portal venous obstruction.  Br J Surg . 1965;  152 129-39
    PubMedGoogle Scholar
  • 8 Maddrey W C, Basu Mallik C H, Iber F L. Extrahepatic portal obstruction of the portal venous system.  Surg Gynaecol Obstet . 1968;  127 989-998
    PubMedGoogle Scholar
  • 9 Myers N A, Robinson M J. Extrahepatic portal hypertension in children.  J Pediatr Surg . 1973;  8 467-473
    CrossrefPubMedGoogle Scholar
  • 10 Odievre M, Pige G, Alagille D. Congenital abnormalities associated with extrahepatic portal hypertension.  Arch Dis Child . 1977;  52 383-385
    PubMedGoogle Scholar
  • 11 Thompson E N, Sherlock S. The aetiology of portal vein thrombosis with particular reference to the role of infection and exchange transfusion.  Q J Med . 1964;  33 465-480
    PubMedGoogle Scholar
  • 12 Househam K C, Bowie M D. Extrahepatic portal venous obstruction.  S Afr Med J . 1983;  64 234-236
    PubMedGoogle Scholar
  • 13 Boles E T, Wise W E, Birken G. Extrahepatic portal hypertension in children. Long-term evaluation.  Am J Surg . 1986;  151 734-739
    CrossrefPubMedGoogle Scholar
  • 14 Cardin F, Graffeo M, McCormick P A. Adult ``idiopathic'' extrahepatic venous thrombosis: importance of putative ``latent'' myeloproliferative disorders and comparison with cases with known etiology.  Dig Dis Sci . 1992;  37 335-339
    CrossrefPubMedGoogle Scholar
  • 15 Stringer M D, Heaton N D, Karani J. Patterns of portal vein occlusion and their aetiological significance.  Br J Surg . 1994;  81 1328-1331
    PubMedGoogle Scholar
  • 16 Orozco H, Takahashi T, Mercado M A. Surgical management of extrahepatic portal hypertension and variceal bleeding.  World J Surg . 1994;  18 246-250
    CrossrefPubMedGoogle Scholar
  • 17 Orloff M J, Orloff M S, Rambotti M. Treatment of bleeding esophagogastric varices due to extrahepatic portal hypertension: results of portal systemic shunts during 35 years.  J Paediatr Surg . 1994;  29 142-154
    PubMedGoogle Scholar
  • 18 Vleggaar F P, van Buuren R H, Schalm S W. Endoscopic sclerotherapy for bleeding oesophagogastric varices secondary to extrahepatic portal vein obstruction in an adult caucasian population.  Eur J Gastroenterol . 1988;  10 81-85
    PubMedGoogle Scholar
  • 19 Tizard J PM. Portal hypertension following exchange transfusion through the umbilical vein.  Proc R Soc Med . 1962;  55 772-779
    PubMedGoogle Scholar
  • 20 Yadav S, Dutta A K, Sarin S K. Do umbilical vein catheterization and sepsis lead to portal vein thrombosis?.  <~>A prospective, clinical and sonographic evaluation. J Pediatr Gastroenterol Nutr . 1993;  17 392-396
    PubMedGoogle Scholar
  • 21 Guimaraes H, Castelo L, Guimaraes J. Does umbilical vein catheterization to exchange transfusion lead to portal vein thrombosis?.  Eur J Pediatr . 1998;  157 461-463
    CrossrefPubMedGoogle Scholar
  • 22 Larroche J. Umbilical catheterization: its complications.  Biol Neonate . 1970;  16 101-103
    PubMedGoogle Scholar
  • 23 Valla D, Casadevall N, Huisse M G. Myeloproliferative disorders in portal vein thrombosis in adults.  Gastroenterology . 1988;  94 1063-1069
    PubMedGoogle Scholar
  • 24 Denninger M H, Helley D, Valla D. Prospective evaluation of the prevalence of factor V Leiden mutation in portal or hepatic vein thrombosis.  Thromb Haemost . 1997;  78 1297-1298
    PubMedGoogle Scholar
  • 25 Mahmoud A EA, Elias E, Beauchamp N. Prevalence of the factor V Leiden mutation in hepatic and portal vein thrombosis.  Gut . 1997;  40 798-800
    PubMedGoogle Scholar
  • 26 Seixas C A, Hessel G, Ribeiro C C. Factor V Leiden is not common in children with portal vein thrombosis.  Thromb Haemost . 1997;  77 258-261
    PubMedGoogle Scholar
  • 27 Chamouard P, Pencreach E, Maloisel F. Frequent factor II G20210A mutation in idiopathic portal vein thrombosis.  Gastroenterology . 1999;  116 144-148
    CrossrefPubMedGoogle Scholar
  • 28 Jansen H LA, Meinardi J R, Vleggaar F P. Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case-control study.  Blood . 2000;  96 2364-2368
    PubMedGoogle Scholar
  • 29 Egesel T, Buyukasik Y, Dundar S V. The role of natural anticoagulant deficiencies and factor V Leiden in the development of idiopathic portal vein thrombosis.  J Clin Gastroenterol . 2000;  30 66-71
    CrossrefPubMedGoogle Scholar
  • 30 Denninger M H, Chait Y, Casadevall N. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors.  Hepatology . 2000;  31 587-591
    CrossrefPubMedGoogle Scholar
  • 31 Okuda K, Ohnishi K, Kimura K. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients.  Gastroenterology . 1985;  89 279-286
    PubMedGoogle Scholar
  • 32 Groszman R J, Vorbioff J, Riley E. Splanchnic hemodynamics in portal hypertensive rats: measurement with gamma-labeled microspheres.  Am J Physiology . 1982;  242 G156-G160
    PubMedGoogle Scholar
  • 33 Arora R, Mohanty M, Nundy S. Phlebothrombosis as a common pathogenic denominator in noncirrhotic portal fibrosis and extrahepatic portal venous obstruction.  Ind J Med Res . 1984;  79 392-403
    PubMedGoogle Scholar
  • 34 Sengupta K P, Basu Mallik C K, Maddrey W C. Liver changes in extrahepatic portal venous obstruction.  Ind J Med Res . 1968;  56 1643-1650
    PubMedGoogle Scholar
  • 35 Mikkelsen W P, Edmondson H A, Peters R L. Extra and intrahepatic portal hypertension without cirrhosis (hepatopetal sclerosis).  Ann Surg . 1965;  162 602-620
    PubMedGoogle Scholar
  • 36 De Gaetano M A, Lafortune M, Patriquin H. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography.  Am J Radiol . 1995;  165 1151-1155
    PubMedGoogle Scholar
  • 37 Warren W D, Millikan W J, Smith R B. Noncirrhotic portal vein thrombosis. Physiology before and after surgery.  Ann Surg . 1980;  192 341-349
    PubMedGoogle Scholar
  • 38 Dilawari J B, Chawla Y K. Spontaneous (natural) splenoadenorenal shunts in extrahepatic portal venous obstruction: a series of 20 cases.  Gut . 1987;  28 1198-1200
    PubMedGoogle Scholar
  • 39 Lebrec D, Bataille C, Bercoff E. Hemodynamic changes in patients with portal venous obstruction.  Hepatology . 1983;  3 550-553.
    PubMedGoogle Scholar
  • 40 Sarin S K. Noncirrhotic portal hypertension. In: Bosch J, Groszman R, eds. Portal Hypertension: Pathophysiology and Treatment Oxford, UK: Blackwell Science 1994: 27-53
    Google Scholar
  • 41 Braillon A, Moreau R, Hadengue A. Hyperkinetic circulatory syndrome in patients with presinusoidal portal hypertension: effect of propranolol.  J Hepatol . 1989;  9 312-318
    PubMedGoogle Scholar
  • 42 Voigt M D, Trey G, Levitt N S. Autonomic neuropathy in extra-hepatic portal vein thrombosis: evidence for impaired autonomic reflex arc.  J Hepatol . 1997;  26 634-641
    CrossrefPubMedGoogle Scholar
  • 43 Manisha R, Sinha S, Kapoor D. Prevalence of autonomic dysfunction in cirrhotic and non-cirrhotic portal hypertension.  Am J Gastroenterol (in press) . 2002; 
    PubMedGoogle Scholar
  • 44 MacGilchrist A J, Reid J L. Impairment of autonomic reflex in cirrhosis.  Am J Gastroenterol . 1990;  85 288-292
    PubMedGoogle Scholar
  • 45 Gaudin C, Braillon A, Poo J L. Plasma catecholamines in patients with presinusoidal portal hypertension: comparison with cirrhotic patients and non portal hypertensive subjects.  Hepatology . 1991;  13 913-916
    CrossrefPubMedGoogle Scholar
  • 46 Thompson E N, Williams R, Sherlock S. Liver function in extrahepatic portal hypertension.  Lancet . 1964;  2 1352-1356
    PubMedGoogle Scholar
  • 47 Misra A, Guptan R C, Sarin S K. Monoethylglycinexylidide (MEGX): a sensitive noninvasive method to differentiate NCPF and child's A chronic liver disease.  Ind J Gastroenterol . 1997;  16(Suppl 2) 101
    PubMedGoogle Scholar
  • 48 Sarin S K, Agarwal S R. Idiopathic portal hypertension.  Digestion . 1998;  59 420-423
    CrossrefPubMedGoogle Scholar
  • 49 Baggenstoss A H, Wallaeger E E. Portal hypertension due to chronic occlusion of the extrahepatic portion of the portal vein: its relation to ascites.  Am J Med . 1956;  21 16-19
    CrossrefPubMedGoogle Scholar
  • 50 Reichen J. Liver function and pharmacological considerations in pathogenesis and treatment of portal hypertension.  Hepatology . 1990;  11 1066-1078
    PubMedGoogle Scholar
  • 51 Rozga J, Jeppsson B, Bengmark S. Hepatotrophic factors in liver growth and atrophy.  Br J Exp Pathol . 1985;  66 669-678
    PubMedGoogle Scholar
  • 52 Farrel G C, Koltai A, Zaluzny L. Effects of portal vein ligation on sex hormone metabolism in male rats: relationship to lowered hepatic cytochrome P450 levels.  Gastroenterology . 1986;  90 299-305
    PubMedGoogle Scholar
  • 53 Sarin S K, Bansal A, Sasan S. Portal-vein obstruction in children leads to growth retardation.  Hepatology . 1992;  15 229-233
    CrossrefPubMedGoogle Scholar
  • 54 Hahn M, Massen O, Nencki M. Die eckache fistel zwischen der unteren Hahevene und der pfortaden und folgen furden organismus.  Arch Exp Pathol Pharmakol . 1893;  32 162-210
    PubMedGoogle Scholar
  • 55 Mehrotra R N, Bhatia V, Dabadghao P. Extrahepatic portal vein obstruction in children: anthropometry, growth hormone, and insulin-like growth factor 1.  J Paediatr Gastroenterol Nutr . 1997;  25 520-523
    PubMedGoogle Scholar
  • 56 Fraser J, Brown A K. A clinical syndrome associated with a rare anomaly of vena portel system.  Surg Gynecol Obstet . 1944;  78 520-524
    PubMedGoogle Scholar
  • 57 Gibson J B, Johnston G W, Fulton T T. Extrahepatic portal venous obstruction.  Br J Surg . 1965;  52 129-139
    CrossrefPubMedGoogle Scholar
  • 58 Nagral A S, Dalvi B V, Khanna M U. Intrapulmonary vascular dilatation with hypoxemia in extrahepatic portal vein obstruction.  Ind J Gastroenterol . 1993;  12 149-151
    PubMedGoogle Scholar
  • 59 Behera D, Singh M, Chawla Y. Pulmonary function abnormality in patients with portal hypertension with or without chronic liver disease.  Ind J Chest Dis Allied Sci . 1998;  40 33-39
    PubMedGoogle Scholar
  • 60 Sarin S K, Bhatia V, Makwane U. ``Portal biliopathy'' in extrahepatic portal vein obstruction.  Ind J Gastroenterol . 1992;  11 82
    PubMedGoogle Scholar
  • 61 Dilawari J B, Chawla Y K. Pseudosclerosing cholangitis in extrahepatic portal venous obstruction.  Gut . 1992;  33 272-276.
    PubMedGoogle Scholar
  • 62 Khuroo M S, Yattoo G N, Zargar S A. Biliary abnormalities associated with extrahepatic portal venous obstruction.  Hepatology . 1993;  17 807-813
    CrossrefPubMedGoogle Scholar
  • 63 Malkan G H, Bhatia S J, Bashir K. Cholangiopathy associated with portal hypertension: diagnostic evaluation and clinical implications.  Gastrointest Endosc . 1999;  49 344-348
    CrossrefPubMedGoogle Scholar
  • 64 Nagi B, Kochhar R, Bhasin D. Cholangiopathy in extrahepatic portal venous obstruction.  Acta Radiol . 2000;  41 612-615
    CrossrefPubMedGoogle Scholar
  • 65 Chandra R, Kapoor D, Tharakan A. Portal biliopathy.  J Gastroenterol Hepatol . 2001;  16 1086-1092
    CrossrefPubMedGoogle Scholar
  • 66 Dhiman R K, Puri P, Chawla Y. Biliary changes in extrahepatic portal venous obstruction: compression by collaterals or ischemic?.  Gastrointest Endosc . 1999;  50 646-652
    CrossrefPubMedGoogle Scholar
  • 67 Bhatia V, Jain A K, Sarin S K. Choledocholithiasis associated with portal biliopathy in patients with extrahepatic portal vein obstruction: management with endoscopic sphincterotomy.  Gastrointest Endosc . 1995;  42 178-181
    CrossrefPubMedGoogle Scholar
  • 68 Kochlar S, Kochhar R, Nagi B. Portal billopathy in extrahepatic and intrahepatic portal hypertension.  J Gastroenterol Hepatol . 2001;  16(Suppl) A78
    PubMedGoogle Scholar
  • 69 Chawla A, Dewan R, Sarin S K. The frequency and influence of gallbladder varices on gallbladder functions in patients with portal hypertension.  Am J Gastroenterol . 1995;  90 2010-2014
    PubMedGoogle Scholar
  • 70 Prasad C VR, Kaur U, Marwaha N. Hemostatic alterations in non-cirrhotic portal fibrosis, extrahepatic portal venous obstruction and Budd-Chiari syndrome.  Ind J Gastroenterol . 1990;  9 57-69
    PubMedGoogle Scholar
  • 71 Sheth S G, Deo A M, Bichile S K. Coagulation abnormalities in non-cirrhotic portal fibrosis and extra hepatic portal vein obstruction.  J Assoc Physicians India . 1996;  44 790-791
    PubMedGoogle Scholar
  • 72 Robson S C, Kahn D, Kruskal J. Disordered hemostasis in extrahepatic portal hypertension.  Hepatology . 1993;  18 853-857
    CrossrefPubMedGoogle Scholar
  • 73 Bajaj J S, Bhattacharjee J, Sarin S K. Coagulation profile and platelet function in patients with extrahepatic portal vein obstruction and non-cirrhotic portal fibrosis.  J Gastroenterol Hepatol . 2001;  16 641-646
    CrossrefPubMedGoogle Scholar
  • 74 Webb L J, Ross M, Markham R L. Immune function in patients with extrahepatic portal venous obstruction and the effect of splenectomy.  Gastroenterology . 1980;  79 99-103
    PubMedGoogle Scholar
  • 75 Robson S C, Saunders R H, Kruskal J B. Immune dysfunction in extrahepatic portal hypertension-identification of immunosuppressive factors.  Hepatology . 1988;  8 1428
    PubMedGoogle Scholar
  • 76 Seth A, Yadav S, Sasan S. Systemic and gut mucosal immunity in children with extrahepatic portal vein obstruction.  Ind J Gastroenterol . 1992;  11 81
    PubMedGoogle Scholar
  • 77 Sarin S K, Lahoti D, Saxena S P. Prevalence, classification and natural history of gastric varices: long-term follow-up study in 568 patients with portal hypertension.  Hepatology . 1992;  16 1343-1349
    CrossrefPubMedGoogle Scholar
  • 78 Sarin S K, Dasika V, Sreenivas, et al. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension.  Gastroenterology . 1992;  102 994-999
    PubMedGoogle Scholar
  • 79 Sarin S K, Shahi H M, Jain M. The natural history of portal hypertensive gastropathy: influence of variceal eradication.  Am J Gastroenterol . 2000;  95 2888-2893
    CrossrefPubMedGoogle Scholar
  • 80 Ganguly S, Sarin S K, Bhatia V. The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension.  Hepatology . 1995;  21 1226-1231
    CrossrefPubMedGoogle Scholar
  • 81 Chawla Y, Dilawari J B. Anorectal varices: their frequency in cirrhotic and non-cirrhotic portal hypertension.  Gut . 1991;  32 309-311
    CrossrefPubMedGoogle Scholar
  • 82 Voorhees A B, Price J B. Extrahepatic portal hypertension. A retrospective analysis of 127 cases and associated clinical implications.  Arch Surg . 1974;  108 338-341
    PubMedGoogle Scholar
  • 83 Zwiebel W J. Sonographic diagnosis of hepatic vascular disorders.  Semin Ultrasound CT MR . 1995;  16 34-48
    CrossrefPubMedGoogle Scholar
  • 84 Fonkalsrud E W, Myers N A, Robinson M J. Management of extrahepatic portal hypertension in children.  Ann Surg . 1974;  180 487-493
    PubMedGoogle Scholar
  • 85 Clatworthy H W, Boles E T. Extrahepatic portal bed block in children: pathogenesis and treatment.  Ann Surg . 1959;  150 371-383
    PubMedGoogle Scholar
  • 86 Voorhees A B, Chaitman E, Schneider S. Portal-systemic encephalopathy in the noncirrhotic patient. Effect of portal systemic shunting.  Arch Surg . 1973;  107 659-663
    PubMedGoogle Scholar
  • 87 Kahn D, Terblanche J, Kitane S. Injection sclerotherapy in adults with extrahepatic portal venous obstruction.  Br J Surg . 1987;  74 600-602
    PubMedGoogle Scholar
  • 88 Howard E R, Stringer M D, Mowat A P. Assessment of injection sclerotherapy in management of 152 children with esophageal varices.  Br J Surg . 1988;  75 404-408
    CrossrefPubMedGoogle Scholar
  • 89 Dilawari J B, Chawla Y K, Ramesh G N. Endoscopic sclerotherapy in children.  J Gastroenterol Hepatol . 1989;  4 155-160
    PubMedGoogle Scholar
  • 90 Chawla Y K, Dilawari J B, Ramesh G N. Sclerotherapy in extrahepatic portal venous obstruction.  Gut . 1990;  31 213-216
    CrossrefPubMedGoogle Scholar
  • 91 Bhargava D K, Dasarathy S, Sundaram K R. Efficacy of endoscopic sclerotherapy on long-term management of oesophageal varices: a comparative study of results in patients with cirrhosis of the liver, non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHO).  J Gastroenterol Hepatol . 1991;  6 471-475
    CrossrefPubMedGoogle Scholar
  • 92 Yachha S K, Sharma B C, Kumar M. Endoscopic sclerotherapy for esophageal varices in children with extrahepatic portal venous obstruction: a follow-up study.  J Pediatr Gastroenterol Nutr . 1997;  24 49-52
    CrossrefPubMedGoogle Scholar
  • 93 Sarin S K, Agarwal S R. Gastric varices and portal hypertensive gastropathy.  Clin Liver Dis . 2001;  5 727-767
    CrossrefPubMedGoogle Scholar
  • 94 Fonkalsrud E W. Surgical management of portal hypertension in childhood: long term results.  Arch Surg . 1980;  115 1042-1045
    PubMedGoogle Scholar
  • 95 Bismuth H, Franco D. Portal diversion for portal hypertension in early childhood.  Ann Surg . 1976;  183 439-446
    PubMedGoogle Scholar
  • 96 Bismuth H, Franco D, Alagille D. Portal diversion for portal hypertension in children. The first ninety patients.  Ann Surg . 1980;  192 18-24
    PubMedGoogle Scholar
  • 97 Alvarez F, Bernard O, Brunelle F. Portal obstruction in children. II. Results of surgical portasystemic shunts.  J Pediatr . 1983;  103 703-707
    PubMedGoogle Scholar
  • 98 Pande G K, Sahni P, Nundy S. Extrahepatic obstruction causing portal hypertension.  J Gastroenterol Hepatol . 1988;  3 99-107
    PubMedGoogle Scholar
  • 99 Mitra S K, Rao K LN, Narasimhan K L. Side-to-side lienorenal shunt without splenectomy in non-cirrhotic portal hypertension in children.  J Pediatr Surg . 1993;  28 398-402
    PubMedGoogle Scholar
  • 100 Prasad S A, Gupta S, Kohli V. Proximal splenorenal shunts for extrahepatic portal venous obstruction in children.  Ann Surg . 1994;  219 193-196
    PubMedGoogle Scholar
  • 101 Warren W D, Henderson J M, Millikan W J. Management of variceal bleeding in patients with noncirrhotic portal vein thrombosis.  Ann Surg . 1988;  207 623-634
    PubMedGoogle Scholar
  • 102 Henderson J M, Millikan W J, Galambos J T. Selective variceal decompression in portal vein thrombosis.  Br J Surg . 1984;  71 745-749
    PubMedGoogle Scholar
  • 103 Alagille D, Carlier J C, Chiva M. Long-term neuropsychological outcome in children undergoing portal systemic shunts for portal vein obstruction without liver disease.  J Pediatr Gastroenterol Nutr . 1986;  5 861-886
    PubMedGoogle Scholar
  • 104 Guharay B N, Sain P, Ramerjee D. Direct splenocaval shunt for selective decompression of portal hypertension in children.  Surgery . 1980;  87 271-279
    PubMedGoogle Scholar
  • 105 Maksoud J G, Miles S. Distal splenorenal shunt in children.  Ann Surg . 1982;  195 401-405
    PubMedGoogle Scholar
  • 106 Cohen J, Edelman R R, Chopra S. Portal vein thrombosis: a review.  Am J Med . 1992;  92 173-181
    CrossrefPubMedGoogle Scholar
  • 107 Yoshioka H, Kuroda C, Hori S. Splenic embolization for hypersplenism using steel wires.  Am J Radiol . 1985;  144 1269-1274
    PubMedGoogle Scholar
  • 108 Sangro B, Billao I, Herraro J. Partial splenic embolization for the treatment of hypersplenism in cirrhosis.  Hepatology . 1993;  18 309-314
    CrossrefPubMedGoogle Scholar
  • 109 Kenawi M M, El Ghamrawi K A, Mohammad A A. Splenic irradiation for the treatment of hypersplenism.  Br J Surg . 1997;  84 860-861
    CrossrefPubMedGoogle Scholar
  • 110 Chaudhary A, Dhar P, Sarin S K. Bile duct obstruction due to portal biliopathy in extrahepatic portal hypertension: surgical management.  Br J Surg . 1988;  85 326-329
    PubMedGoogle Scholar
  • 111 Kato T, Romero R, Koutouby R. Portosystemic shunting in children during the era of endoscopic therapy: improved postoperative growth parameters.  J Pediatr Gastroenterol Nutr . 2000;  30 419-425
    CrossrefPubMedGoogle Scholar