DOI: 10.363247/sjmcr.2018.v06i10.024

Pages: 828-833

The portal cavernoma is the most common cause of portal hypertension in children responsible for important morbidity linked to gastrointestinal bleeding. This study aims to elucidate the main therapeutic advances in the surgical treatment of portal cavernoma. We are conducting a retrospective study on 10 children affected by portal cavernoma and compiled at surgery "A" of Rabat children's hospital between 2000 and 2017. The average age of patients was 10.7 years and the sex ratio was 1. The reason for hospitalization was gastro-intestinal bleeding in 7 cases and splenomegaly in 3 cases. Biology has shown hypersplenism in all our patients, the prothombin time (PT) was elongated in 8 cases and liver function tests were abnormal in 1 case. The gastrointestinal endoscopy showed oesophageal varices steadily. The ultrasound, with or without a Doppler, established the diagnosis in all cases. The treatment was endoscopic in 2 cases and surgical in 8 cases consisting of a distal splenorenal shunt in 2 cases, a spleno-caval shunt in 1 case, a meso-caval venous interposition shunt in 2 cases and splenectomy in 3 cases. The evolution of the patients was generally good with permeable shunts and a regression of hypersplenism. Also, no recurrence of bleeding was seen in 8 cases. However, 2 of the surgical interventions were complicated by portal vein thrombosis. This study has enabled us to understand better the pathology of portal cavernoma and its repercussions that could be disastrous. Accordingly, an appropriate therapeutic decision must be taken as soon as possible especially after the advent of Mesoportal bypass.