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KMID : 0390119960360010157
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Journal of Pusan Medical College
1996 Volume.36 No. 1 p.157 ~ p.166
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A clinical study of Extrahepatic Portal Hypertension
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Abstract
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Extrahepatic portal hypertension, usually caused by thrombosis or cavernomatous transformation of the portal vein, is a relatively uncommon cause of bleeding gastrointestinal or intestinal varices, but it is one which merits special
consideration.
The
salient questions concerning this disorder relate to the general prognosis, including the course of the non-shunted patient, the applicability of decompressive shunting procedures and the risk of consequent encephalopathy.
For 10 years, from January 1985 to December 1994, 105 patients were diagnosed and operated because of portal hypertension at Department of Surgery, PNUH, among which 18 patients had extrahepatic portal hypertension.
The author reviewed available clinical records of 16 patients with extrahepatic hypertension and obtained the following results.
1) The proportion of extrahepatic portal hypertension to total cases with portal hypertension was 17.1%.
2) According to first visit, 13 cases were distributed within 30 years-old(81.3%), and male to female ratio was 11:5.
3) The main clinical manifestation was hematemesis in 16 cases. Splenomegaly was presented in 14 cases and 3 cases revealed hypersplenism. Other symptoms and signs were melena in 14 cases, abdominal pain in 10 cases, ascites in 2 cases,
hepatomegaly in
2 cases.
4) In laboratory analysis, elevation of AST and ALT were in 2 cases preoperatively, and recovered to normal level after operation. Platelet count was lower than 100,000/mm3 in 3 cases preoperatively, but recovered to normal level after
operation.
5) The most frequent cause of extrahepatic portal hypertension was portal vein thromosis. And the locations of extrahepatic portal venous obstruction were cases which involved only portal vein and cases which involved splenic vein and superior
mesenteric vein as well as portal vein. In 5 cases, the causes could not be found.
6) The predisposing factors were present in 3 cases, among which omphalitis of neonatal peiod were in 1 case, sepsis of infantile period in 1 case, and traumatic pancreatic injury in case.
7) Preoperative splenoportography and celiac angiography were done. And intraoperative splenoportography was done in 5 cases. Preoperative dopplermeter defined normal hepatic blood flow in 2 case.
8) The portal venous pressure was measured during operation in 12 cases, 66.6% of cases showed 200~400 mmH2O in portal venous pressure and pressure decrement after operation averaged 127.6 mmH2O. In cases with higher pre-operative portal venous
pressure more conspicuous decompressive effect of operation was noted.
9) Eighteen operation were done in 16 patients. At first operation there were splenorenal shunt in 7 cases, splenectomy in 3 cases, mesorenal shunt in 2cases, coronocaval shunt in 1 case, Sugiura's procedure in 1 case, Warren shunt in 1 case,
primary
ligation of varices in 1 case. Among which, 1 case of proximal splenorenal shunt was reoperated to portocaval shunt and in 1 case of splenectomy was reoperated to mesocaval shunt. And in case of primary ligation, splenic artery embolization was
done
because of rebleeding.
10) The postoperative mortality was 0% and complications were rethrombosis in 2 cases, rebleeding in 4 cases, post-shunt encephalopathy in 1 case, reflux alkaline esophagitis in 1 case.
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