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Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience.
MedLine Citation:
PMID:  24647294     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and severe according to the pre-operative CT portogram. Mild, moderate and severe infarcts were defined as an infarct involving < 25%, 25-50% and > 50% area of the spleen, respectively. Mild and moderate infarcts were managed by spleen-preserving distal splenorenal shunt while those with extensive infarcts were subjected to splenectomy and proximal splenorenal shunt. Those with spleen-preserving shunts were closely followed in the post-operative period according to a uniform protocol. Clinical examination was regularly done to assess the size of the spleen and note the presence of pain, tenderness in the left intercostal space. An ultrasound Doppler was done after 7 days to assess shunt patency while CT portogram was repeated at 6 monthly intervals. Results: Fourteen cases with splenic infarcts formed the study group. Eight cases had mild infarcts, 3 had moderate infarcts and 3 had severe infarcts. Four underwent proximal splenorenal shunt, and 10 underwent warren's shunt (8 with mild and 2 with moderate infarcts). In 9/10 (90%), spleen could eventually be retained. Spleen completely regressed in them and so did the infarct. Conclusions:Spleen-preserving distal splenorenal shunt can be considered as a viable option in the management of cases with mild and carefully selected moderate splenic infarcts.
Authors:
Arbinder Kumar; Nitin Sharma; Minu Bajpai; Shasanka Shekhar Panda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  African journal of paediatric surgery : AJPS     Volume:  11     ISSN:  0974-5998     ISO Abbreviation:  Afr J Paediatr Surg     Publication Date:    2014 Jan-Mar
Date Detail:
Created Date:  2014-03-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101255062     Medline TA:  Afr J Paediatr Surg     Country:  Nigeria    
Other Details:
Languages:  eng     Pagination:  48-51     Citation Subset:  IM    
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