Portal hypertension caused by portal vein thrombosis in children: report of the experience of a single center with emphasis on treatments and results

Purpose: Portal vein thrombosis is the most common cause of portal hypertension in children. This study aims to present the experience of a large university center by analyzing patients with portal hypertension caused by portal vein thrombosis, in search of prognostic factors, types of treatments, and results. Methods: Retrospective analysis of 110 pediatric patients treated from 2000 to 2019 that were divided into two groups: endoscopic procedures (67 patients) and surgical assistance protocols (43 patients). Results: Among the patients from the surgical protocol, 22 underwent the meso-Rex shunt, and 21 underwent other surgical techniques: distal spleno renal shunt (11 patients), azigoportal dissociation with partial splenectomy (6 patients), mesocaval shunt (4 patients). Five meso-Rex patients developed graft thrombosis (5/22; 22.72%). There were no differences between the groups regarding endoscopic findings (first and last), no correlation with the need for surgery, and no definition of initial endoscopic characteristics that could predict worsening disease. The only observed difference was the increase in platelets in the surgical group (median 25.02 thousand/mL, interquartile interval 118.00) that was greater than that observed in the endoscopic group (-42.50 thousand/mL, interquartile interval 56, p<0.001, Mann-Whitney test). Only umbilical catheterization could predict exclusive endoscopic treatment. Conclusion: As the evolution of children treated endoscopically was not different from that of those treated surgically, we conclude that a more conservative approach should be adopted whenever possible.