Long-term outcomes of transmesenteric portal vein recanalization for the treatment of chronic portal vein thrombosis after pediatric liver transplantation.

Portal vein thrombosis (PVT) may occur at any time following liver transplantation. We describe our experience with portal vein recanalization in cases of thrombosis after liver transplantation. Twenty-eight children (5%) out of 566 liver transplant recipients underwent portal vein recanalization using a transmesenteric approach. All children received left hepatic segments, developed PVT, and had symptoms or signs of portal hypertension. Portal vein recanalization was performed via the transmesenteric route in all cases. Twenty-two (78.6%) patients underwent successful recanalization and stent placement. They received oral anticoagulants after the procedure, and clinical symptoms subsided. Symptoms recurred due to portal vein restenosis/thrombosis in seven patients. On an intention-to-treat basis, the success rate of the proposed treatment was 60.7%. Only 17 out of 28 children with posttransplant chronic PVT retained stent patency (primary + assisted) at the end of the study period. In cases of portal vein obstruction, the transmesenteric approach via minilaparotomy is technically feasible with good clinical and hemodynamic results. It is an alternative procedure to reestablish the portal flow to the liver graft that can be performed in selected cases and a therapeutic addition to other treatment strategies currently used to treat chronic PVT.

Acuidade do enema opaco pela técnica de Neuhauser no diagnóstico de doença de Hirschsprung / Accuracy of barium enema with Neuhauser's technique in the diagnosis of Hirschsprung's disease

Avaliamos retrospectivamente 14 pacientes de grupos etários variados, com quadro clínico de constipaçäo intestinal e que foram submetidos, no período de 1976 a 1989, a biópsia retal para confirmaçäo do diagnóstico de doença de Hirschsprung. Fizemos a correlaçäo entre enema opaco pela técnica de Neuhauser, manometria anorretal e biópsia retal. Concluimos que a doença é mais comum no sexo masculino; a localizaçäo do segmento agangliônico é mais frequente no reto e no sigmóide; a maioria das crianças com doença de Hirschsprung inicia com sintomas logo após o nascimento; o enema opaco pela técnica de Neuhauser apresenta acurácia de cerca de 80 p/cento no diagnóstico da doença de Hirschsprung, o que näo é suficiente para ser usado como método único na avaliaçäo da criança obstipada; a manometria anorretal, associada ao enema opaco pela técnica de Neuhauser, obtiveram acurácia de 100 p/cento quando houve concordância entre os métodos