Extrahepatic Portal Vein Thrombosis in Childhood: Risk Factors, Clinical Manifestations, and Management.

OBJECTIVE: Extrahepatic portal vein thrombosis (EHPVT) is a common cause of portal hypertension in children. The aim of the present study was to identify the clinical manifestations and the risk factors for development of EHPVT in pediatric patients. SUBJECTS AND METHODS: This was a single-center retrospective cohort study. A total of 12 children (6 boys and 6 girls) took part in the study. We noted the clinical presentations and the predisposing risk factors for development of EHPVT in all patients. In addition, as all of them had undergone an esophagogastroduodenoscopy for detection and grading of esophageal varices as part of the treatment algorithm, we analyzed the endoscopic findings and the therapeutic approach. RESULTS: The median age of subjects at diagnosis was 3.5 years (range: 1-17 years). The most frequent initial clinical manifestation was upper gastrointestinal bleeding (6 cases, 50.0%) followed by splenomegaly (3 cases, 25.0%). The most frequent systemic risk factor for EHPVT was presence of inherited prothrombotic disorder (10 cases, 83.3%), and the most common local risk factor for EHPVT was umbilical vein catheterization (5 cases, 41.7%). Esophageal varices were revealed in all the study participants, and in the most cases, they were grade ≥2. Propranolol was used as primary or secondary prophylaxis in 7 children (58.3%), and in 5 children (41.7%), a shunt was performed (Meso-Rex bypass in 3 children and splenorenal shunt in 2 children). CONCLUSION: Patients with known systemic or local risk factors for EHPVT are indicated for proactive ultrasound screening for early diagnosis and timely management.

Gallbladder polyp in children - a rare finding during ultrasound examination.

Gallbladder polyps are a relatively rare finding in children. The increased use of high-resolution ultrasound in childhood allows to detect gallbladder lesions in young patients. A precise diagnosis can be established using different imaging series. Abdominal contrast-enhanced ultrasound examination provides the most accurate imaging information about the nature and size of the lesion. This is important for further decisions regarding patient referral for cholecystectomy. The object of this study was to present a case of gallbladder polyp diagnosed and followed up by contrast-enhanced ultrasound.

Therapeutic algorithm in cases with congenital diaphragmatic hernia of the Bochdalek type.

UNLABELLED: The PURPOSE of the present study was to establish the treatment results of the applied approach for preoperative stabilization through mechanical ventilation and delayed surgical intervention as opposed to emergency surgical treatment in children with congenital diaphragmatic hernia. PATIENTS AND METHODS: Twenty-seven children have been treated (nine girls and 18 boys, twenty-four of them--newborns) over a ten-year period. The criteria for successful stabilization are arterial saturation of SaO2 90%, PaO2 = 90-100 mm Hg, PaCO2 40 mm Hg, pH 7.35. RESULTS: Twenty-five of the children were with left-sided hernia (92.59%) and only two (7.41%) with right-sided hernia. The stabilization period ranged from 1 to 4 days, mean 1.48 +/- 0.18 (Sx = 0.81). Preoperatively, in eighteen newborns we used conventional mechanical ventilation; in one child only we used high frequency oscillating ventilation. In three children we failed to achieve stabilization and after worsening of their condition they died before they could be operated. In all children, postoperative mechanical ventilation was applied from 3 to 16 days, mean 7 +/- 0.65 (Sx = 3.16). The mortality was 59.26%. CONCLUSIONS: The approach used for delayed surgical treatment has significant advantages compared to the urgent correction of the congenital diaphragmatic hernia. It provides opportunities for stabilization of the gas exchange and pulmonary circulation but still mortality remains high. New therapeutic techniques such as antenatal intervention or pulmonary transplantation are probably needed to save the lives of such patients.