Publication:

Non bleeding manifestations in children with extrahepatic portalvein obstruction

Background Extra hepatic portal venous obstruction is the commonest type of portal hypertension (EHPVO) in children, apart from variceal bleeding.  Other features include anemia, hypersplenism, protein losing enteropathy, growth retardation and portal biliopathy. The main objective is to study the bleeding and non-bleeding manifestations in South Indian children with EHPVOMethods: A prospective descriptive study on children from 1-12 years of age with (EHPVO) from a tertiary care pediatric centre in Chennai, India. Study period was for one year. Children with EHPVO were recruited based on clinical features, USG abdomen findings, liver function tests with or without varices on upper GI endoscopy. They were divided into 2 groups; Bleeders (group 1) and non-bleeders (group 2). Statistical Analysis used was Chi square test and Student t test.

Results There were 48 children with male, female ratio of 0.9:1. History of umbilical sepsis was present in 20.8%.   Recurrent variceal bleed was the common presentation seen in the majority (83.3%) more so in   rural children between 5-15 years (p- 0.025). Non - bleeding manifestations observed were splenomegaly (95.8%), hypersplenism (37.5%) as age advances (p-0.038), anemia (91.6%), ascites (10.4%), and epistaxis (6.25), growth retardation less than 3rd centile (22.7%). Associated comorbid conditions include insulin dependent diabetes mellitus (4%), atrial septal defect (2%).

Conclusions Upper GI bleeding was the common presentation in majority of  children between 5-15 years in group 1 and in group II  hypersplenism (37.8%), anemia ( 91.6%) 2 were common. Deranged liver function was noted in 10.4% and growth retardation in 22.7%. One should look for associated congenital anomalies though rare in children.