Patency of spleno-pancreatorenal shunt in infant with portal hypertension, case series and literature review

Introduction: Portal hypertension is the main cause of morbidity and mortality in infant diagnosed of biliary atresia (BA) and cavernous deformation of the portal vein. Portal hypertension evolves as a result of increased intrahepatic vascular resistance, most commonly caused by a chronic liver disease. The clinical manifestations are ascites and bleeding owing the esophageal and gastric varices. The mortality rate per acute episode of bleeding is 5% to 19% in children. The aim of this work was to evaluate the clinical influence of rebleeding, refractory ascites, child-Pugh class (C.P) and shunt patency in infant underwent spleno-pancreatorenal (SPR) shunt in a case series in a pediatric reference medical center. Patients and Methods: Retrospective and observational work was performed owing clinical surveillance of C.P, shunt patency, rebleeding and ascites formation after SPR shunt procedure from December 2017 to November 2020. Of 16 shunts performed in this period, 3(18.7%) patients had SPR shunt. The three patients were females and the mean weight was 6.5kg. Outcomes and Results: The search identified three patients underwent surgical shunts of SPR less than 2-year-old. All of three patients had shunt patency in the first three months from the procedure. One patient had thrombosis of the shunt at fourth month from the operation. The three patients had improvement in the C.P class, 1 patient had infectious, rebleeding and ascites between 4 months from the procedure. Conclusion: The three patients had no experienced shunt complications in the first three months from the procedure.