Long term maintenace of transjugular intrahepatic portosystemic shunt in

children

Case report

Young Ju Hong M.D., Seonae Ryu, Hye Kyung Chang M.D., Jung Tak Oh M.D., Seok Joo Han M.D.

Department of Pediatric SurgerySeverance Children`s Hospital

Department of SurgeryYonsei University College of Medicine

BackgroundTransjugular intrahepatic portosystemic shunt(TIPS) Complications of severe portal hypertension Endoscopic, pharmacologically failed

Refractory life threatening variceal bleeding Refractory ascites

Temporary(bridge to transplantation) Technically demanding procedure

Case – History of illness F/13Y

Birth History• IUP 40 wks, BW 3.1 kg, NSVD

At 65 days : Kasai operation d/t Biliary atresia• CMV negative, postoperative jaundice free

At age 3(2003.01) : hematemesis-> beta-blocker start

Case – History of illness At age 4(2003.05) : hematemesis-> 12,3,10 o`clock

sclerotherapy

Case – History of illness At age 4(2003.06) : melena, hematemesis

• 1st TIPS • EGD f/u(7wk) CT f/u(2wks)

Case – History of illness At age 5 ( 1st TIPS 6 개월후 : 2003.12) : melena

• EGD : esophagus: mild venous dilatation without bleeding stigma stomach: fundus prominent vascular marking without dilatation• Conservative treatment

Case – History of illness At age 5 (1st TIPS 9 개월후 :2004.02) : hematemesis

• Doppler US / EGD• 2nd TIPS (revision)

Case – History of illness At age 6 (2nd TIPS 9 개월후 :2004.12) : hematemesis

• Doppler US / EGD• 3rd TIPS (revision)

Case – History of illness At age 9 (3rd TIPS 56 개월후 :2009.07) : hematemesis

• EGD/CT• Doppler US• 4th TIPS (revision)

Case – History of illness At age 9 (4th TIPS 2 주 ) : drawsy mental status

• Laboratory test : T.bil 3.3(2~3) Ammonia 144(70~170)• Brain CT/MRI

Case – History of illness Now

• Age 13• EGD / doppler US

Conclusion

Transjugular intrahepatic portosystemic shunt(TIPS) feasible safe effective in children with portal hypertension

unresponsive to endoscopic and medical treatment

Thank you for your attention