Percutaneous Transhepatic Angioplasty for Portal Vein Cavern
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Cavernous transformation of the portal vein (CTPV), known as portal cavernoma, is caused by stenosis or obstruction of the portal vein. This condition leads to spontaneous bypass across the stenosis, which sustains blood flow and liver function. Most cases of CTPV in children are caused by neonatal septicemia, and umbilical and intra-abdominal infections. However, CTPV has been rarely reported after choledochal cyst surgery. The traditional treatment for CTPV is surgery. We report a case of successful treatment of a CTPV by percutaneous transhepatic angioplasty.

Case Report
A 7-year-old boy was admitted to our center with recurring oral and nasal bleeding. Physical examination revealed splenomegaly and an abdominal scar, and ultrasound examination showed extrahepatic portal vein stenosis (Fig. 1). The boy had a history of a choledochal cyst treated by Roux-en-Y hepatoenterostomy 6 years previously. The patient had no signs of fever or jaundice during the early follow-up period, and ultrasound examination findings were normal for 6 months after the operation. Over a period of next 4 years, his spleen size started increasing, platelet counts decreased, and he developed gastro-intestinal bleeding. Gastroscopy revealed moderately severe varicose veins in the gastric fundus and distal esophagus; barium meal examination showed signs of venous beading at the bottom of the esophagus, indicating a spontaneous portosystemic shunt....

http://www.indianpediatrics.net/dec2016/dec-1107-1108.htm
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