PDF herunterladen
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
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. März 2002 (online)

    Lizenzen und Reprints

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
    PubMedSuche in Google Scholar
  • 2 Alvarez F, Bernard O, Brunelle F. Portal obstruction in children. I. Clinical investigations and hemorrhage risk.  J Pediatr . 1983;  103 696-702
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 5 Rosch J, Dotter C T. Extrahepatic portal obstruction in childhood and its angiographic diagnosis.  Am J Radiol . 1981;  112 143-149
    PubMedSuche in Google Scholar
  • 6 Shaldon S, Sherlock S. Obstruction to the extrahepatic portal system in childhood.  Lancet . 1962;  1 63-67
    PubMedSuche in Google Scholar
  • 7 Gibson J B, Johnson G W, Rodgers H W. Extrahepatic portal venous obstruction.  Br J Surg . 1965;  152 129-39
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 9 Myers N A, Robinson M J. Extrahepatic portal hypertension in children.  J Pediatr Surg . 1973;  8 467-473
    CrossrefPubMedSuche in Google Scholar
  • 10 Odievre M, Pige G, Alagille D. Congenital abnormalities associated with extrahepatic portal hypertension.  Arch Dis Child . 1977;  52 383-385
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 12 Househam K C, Bowie M D. Extrahepatic portal venous obstruction.  S Afr Med J . 1983;  64 234-236
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 19 Tizard J PM. Portal hypertension following exchange transfusion through the umbilical vein.  Proc R Soc Med . 1962;  55 772-779
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 22 Larroche J. Umbilical catheterization: its complications.  Biol Neonate . 1970;  16 101-103
    PubMedSuche in Google Scholar
  • 23 Valla D, Casadevall N, Huisse M G. Myeloproliferative disorders in portal vein thrombosis in adults.  Gastroenterology . 1988;  94 1063-1069
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 27 Chamouard P, Pencreach E, Maloisel F. Frequent factor II G20210A mutation in idiopathic portal vein thrombosis.  Gastroenterology . 1999;  116 144-148
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 39 Lebrec D, Bataille C, Bercoff E. Hemodynamic changes in patients with portal venous obstruction.  Hepatology . 1983;  3 550-553.
    PubMedSuche in Google 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
    Suche in 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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; 
    PubMedSuche in Google Scholar
  • 44 MacGilchrist A J, Reid J L. Impairment of autonomic reflex in cirrhosis.  Am J Gastroenterol . 1990;  85 288-292
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 46 Thompson E N, Williams R, Sherlock S. Liver function in extrahepatic portal hypertension.  Lancet . 1964;  2 1352-1356
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 48 Sarin S K, Agarwal S R. Idiopathic portal hypertension.  Digestion . 1998;  59 420-423
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 50 Reichen J. Liver function and pharmacological considerations in pathogenesis and treatment of portal hypertension.  Hepatology . 1990;  11 1066-1078
    PubMedSuche in Google Scholar
  • 51 Rozga J, Jeppsson B, Bengmark S. Hepatotrophic factors in liver growth and atrophy.  Br J Exp Pathol . 1985;  66 669-678
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 53 Sarin S K, Bansal A, Sasan S. Portal-vein obstruction in children leads to growth retardation.  Hepatology . 1992;  15 229-233
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 57 Gibson J B, Johnston G W, Fulton T T. Extrahepatic portal venous obstruction.  Br J Surg . 1965;  52 129-139
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 60 Sarin S K, Bhatia V, Makwane U. ``Portal biliopathy'' in extrahepatic portal vein obstruction.  Ind J Gastroenterol . 1992;  11 82
    PubMedSuche in Google Scholar
  • 61 Dilawari J B, Chawla Y K. Pseudosclerosing cholangitis in extrahepatic portal venous obstruction.  Gut . 1992;  33 272-276.
    PubMedSuche in Google Scholar
  • 62 Khuroo M S, Yattoo G N, Zargar S A. Biliary abnormalities associated with extrahepatic portal venous obstruction.  Hepatology . 1993;  17 807-813
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 64 Nagi B, Kochhar R, Bhasin D. Cholangiopathy in extrahepatic portal venous obstruction.  Acta Radiol . 2000;  41 612-615
    CrossrefPubMedSuche in Google Scholar
  • 65 Chandra R, Kapoor D, Tharakan A. Portal biliopathy.  J Gastroenterol Hepatol . 2001;  16 1086-1092
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 68 Kochlar S, Kochhar R, Nagi B. Portal billopathy in extrahepatic and intrahepatic portal hypertension.  J Gastroenterol Hepatol . 2001;  16(Suppl) A78
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 72 Robson S C, Kahn D, Kruskal J. Disordered hemostasis in extrahepatic portal hypertension.  Hepatology . 1993;  18 853-857
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 81 Chawla Y, Dilawari J B. Anorectal varices: their frequency in cirrhotic and non-cirrhotic portal hypertension.  Gut . 1991;  32 309-311
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 83 Zwiebel W J. Sonographic diagnosis of hepatic vascular disorders.  Semin Ultrasound CT MR . 1995;  16 34-48
    CrossrefPubMedSuche in Google Scholar
  • 84 Fonkalsrud E W, Myers N A, Robinson M J. Management of extrahepatic portal hypertension in children.  Ann Surg . 1974;  180 487-493
    PubMedSuche in Google Scholar
  • 85 Clatworthy H W, Boles E T. Extrahepatic portal bed block in children: pathogenesis and treatment.  Ann Surg . 1959;  150 371-383
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 87 Kahn D, Terblanche J, Kitane S. Injection sclerotherapy in adults with extrahepatic portal venous obstruction.  Br J Surg . 1987;  74 600-602
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 89 Dilawari J B, Chawla Y K, Ramesh G N. Endoscopic sclerotherapy in children.  J Gastroenterol Hepatol . 1989;  4 155-160
    PubMedSuche in Google Scholar
  • 90 Chawla Y K, Dilawari J B, Ramesh G N. Sclerotherapy in extrahepatic portal venous obstruction.  Gut . 1990;  31 213-216
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar
  • 93 Sarin S K, Agarwal S R. Gastric varices and portal hypertensive gastropathy.  Clin Liver Dis . 2001;  5 727-767
    CrossrefPubMedSuche in Google Scholar
  • 94 Fonkalsrud E W. Surgical management of portal hypertension in childhood: long term results.  Arch Surg . 1980;  115 1042-1045
    PubMedSuche in Google Scholar
  • 95 Bismuth H, Franco D. Portal diversion for portal hypertension in early childhood.  Ann Surg . 1976;  183 439-446
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 97 Alvarez F, Bernard O, Brunelle F. Portal obstruction in children. II. Results of surgical portasystemic shunts.  J Pediatr . 1983;  103 703-707
    PubMedSuche in Google Scholar
  • 98 Pande G K, Sahni P, Nundy S. Extrahepatic obstruction causing portal hypertension.  J Gastroenterol Hepatol . 1988;  3 99-107
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google 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
    PubMedSuche in Google Scholar
  • 105 Maksoud J G, Miles S. Distal splenorenal shunt in children.  Ann Surg . 1982;  195 401-405
    PubMedSuche in Google Scholar
  • 106 Cohen J, Edelman R R, Chopra S. Portal vein thrombosis: a review.  Am J Med . 1992;  92 173-181
    CrossrefPubMedSuche in Google Scholar
  • 107 Yoshioka H, Kuroda C, Hori S. Splenic embolization for hypersplenism using steel wires.  Am J Radiol . 1985;  144 1269-1274
    PubMedSuche in Google Scholar
  • 108 Sangro B, Billao I, Herraro J. Partial splenic embolization for the treatment of hypersplenism in cirrhosis.  Hepatology . 1993;  18 309-314
    CrossrefPubMedSuche in Google 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
    CrossrefPubMedSuche in Google 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
    PubMedSuche in Google 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
    CrossrefPubMedSuche in Google Scholar