All issues > Volume 33(10); 1990

Original Article

J Korean Pediatr Soc. 1990;33(10):1406-1412. Published online October 31, 1990.

A Case of Esophageal Variceal Bleeding in a Child Secondary to Portal Hypertension Associated with Cavernous Transformation of the Portal Vein Suggesting Extrahepatic Portal Obstruction.

Sun Yang Hong¹, Tae Won Oh¹, Jeong Kook Lee¹, Hahng Lee¹, Keun Soo Lee¹, Seok Chol Jeon², Heung Suk Seo²

¹Department of Pediatrics, Hanyang University, College of Medicine, Seoul, Korea
²Department of Diagnostic Radiology, Hanyang University, College of Medicine, Seoul, Korea

Received: June 5, 1990;  Accepted: July 24, 1990.

Abstract

Esophageal variceal bleeding is a rare manifestation in childhood and it usually occurs secondary to portal hypertension. We experienced a case of esophageal variceal bleeding secondary to portal hypertension associated with portal obstruction but with no evidence of liver cirrhosis in a 4-year- and-10-month-old boy who was hospitalized due to hematemesis. He was a product of fullterm normal spontaneous delivery at home unattended by midwife of medical staff, and had a history of abdominal distension requiring oral medication prescribed by a local clinic for one week after birth, but a definite history of omphalitis or sepsis is uncertain. He remained healthy till the sudden onset of bloody vomiting and melena one week prior to amission, when he was noted to have splenomegaly and moderate anemia with hemoglobin level of 6.8 mg/dl at a local clinic and he was transferred to the hospital after transfusion for further evaluation. He was found to have no abnormal physical finding except for an isolated splenomegaly and mild pallor. He was found to have normal liver function test results, normal coagulation profile, normal urinalysis, but mild anemia with hemoglobin level of 9.7 mg/dl and otherwise normal hemogram. Barium meal esophagogram showed tubular or ovoid worm-like filling defects compatible with esophageal varices (Fig. 3) And abdominal sonogram showed splenomegaly and coase echo-pattern of the liver (Fig. 1, 2). but 99mTc liver/spleen scan showed no liver abnormally but splenomegaly (Fig. 4). Arterial portography via superior mesenteric artery and splenic artery revealed moderate splenomegaly, esophageal varices with cavernous transformation of the portal vein, suggestive of preexisting extrahepatic portal obstruction, and revealed no evidence of cirrhotic pattern of the liver (Fig. 5). However liver biopsy was not performed. He was treated by conservative management and is presently followed on an outpatient basis with no further evidence of bleeding and is thriving well over the one year period of follow up. Portal systemic shunt operation is planned for a later date. We report a case of esophageal variceal bleeding secondary to portal hypertension from portal obstruction suggested by cavernous transformation of the portal vein on an arterial portography as the first such case in childhood reported in Korean literature and a brief review of related literatures is presented.

Keywords :Esoophageal Variceal Bleeding, Portal Hypertension, Extrahepatic Portal Obstruction, Cavernous Transformation.