Extrahepatic portal vein obstruction
Last revised by Jeremy Jones on 20 Sep 2021
Citation, DOI, disclosures and article data
Citation:
Goel A, Jones J, Bell D, et al. Extrahepatic portal vein obstruction. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-32082
Permalink:
rID:
32082
Article created:
12 Nov 2014,
Ayush Goel ◉
Disclosures:
At the time the article was created Ayush Goel had no recorded disclosures.
View Ayush Goel's current disclosures
Last revised:
20 Sep 2021,
Jeremy Jones ◉
Disclosures:
At the time the article was last revised Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosures
Revisions:
7 times, by
7 contributors -
see full revision history and disclosures
Systems:
Tags:
Synonyms:
- Extra-hepatic portal vein obstruction (EHPVO)
Extrahepatic portal vein obstruction is the most common cause of non-cirrhotic portal hypertension in children and young adults in developing countries. It may or may not extend into the intrahepatic portal vein.
On this page:
Clinical presentation
It usually occurs in children and young adults, presenting as unexplained gastrointestinal bleeding.
Other features include:
- obstructive jaundice may be seen due to extrahepatic compression of the bile ducts by cavernous collaterals
- splenomegaly
- ascites
Pathology
Etiology
- idiopathic (50% cases)
- children
- neonatal infections
- umbilical venous catheterization
- developmental anomalies
- trauma/surgery
- young adults
- infections
- neoplastic diseases
- pancreatitis
- myeloproliferative disorders
- hypercoagulable states
Cavernous transformation of the portal vein usually occurs to maintain the flow to the liver.
Radiographic features
Ultrasound
Features include:
- normal liver echotexture
- splenomegaly
- splenic hilar collaterals
- cavernous transformation of the portal vein
- ascites
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Treatment and prognosis
Options include:
- endoscopic variceal band ligation
- endoscopic sclerotherapy
-
Rex shunt: mesenterico-left portal vein shunt
- Rex segment (umbilical segment of the left portal vein) must be patent for this
- retrograde portography may be used to identify its patency if non-invasive imaging fails
- Rex segment (umbilical segment of the left portal vein) must be patent for this
- splenorenal shunt (distal or proximal)
See also
References
- 1. Sarin SK, Sollano JD, Chawla YK et-al. Consensus on extra-hepatic portal vein obstruction. Liver Int. 2006;26 (5): 512-9. doi:10.1111/j.1478-3231.2006.01269.x - Pubmed citation
- 2. Poddar U, Borkar V. Management of extra hepatic portal venous obstruction (EHPVO): current strategies. Trop Gastroenterol. 2011;32 (2): 94-102. Pubmed citation
- 3. Sharma MP, Dasarathy S, Misra SC et-al. Sonographic signs in portal hypertension: a multivariate analysis. Trop Gastroenterol. 1996;17 (2): 23-9. Pubmed citation
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