title: Late-onset inferior vena cava obstruction in a shunted patient--a unique cause of rebleeding in children with portal hypertension.
abstract: BACKGROUND
  Rebleeding in the presence of an adequate patent portosystemic shunt in a patient with portal hypertension (PHT) is uncommon. Inferior vena cava (IVC) obstruction as the cause of rebleeding in this situation has not been reported in the literature.
  
  
  METHODS
  Records from a pediatric tertiary care center were reviewed over a 15-year period. Portosystemic shunt procedures for bleeding esophageal varices were done in 39 children. Patients who, after a shunt surgery for PHT, developed a rebleed because of IVC obstruction in the presence of a patent shunt were identified.
  
  
  CONCLUSIONS
  Late IVC obstruction in the presence of a patent shunt was identified in 2 patients. The etiology included adhesions, caudate lobe hypertrophy, and macronodular cirrhosis. Diagnosis was by angiography, and treatment included angioplasty and liver transplantation. Awareness of this condition helps direct treatment appropriately in the clinical scenario of a rebleed in a shunted patient with PHT.
authors.affiliation: Department of Surgery, The Children's Hospital at Westmead, Sydney 2145, NSW, Australia. vincijones@yahoo.co.in
authors.forename: Vinci S
authors.initials: VS
authors.lastname: Jones
authors.forename: Arul Prakash
authors.initials: AP
authors.lastname: Sundaraj
authors.forename: Edward V
authors.initials: EV
authors.lastname: O'Loughlin
authors.forename: Michael
authors.initials: M
authors.lastname: Stormon
authors.forename: David J E
authors.initials: DJ
authors.lastname: Lord
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010690:Phlebography; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology*