title: Clinical classification of congenital extrahepatic portosystemic shunts.
abstract: OBJECTIVE
  Congenital extrahepatic portosystemic shunt (CEPS) is a rare anomaly in which the enteric blood bypasses the liver and drains into the systemic veins through various venous shunts. Patients with CEPS often have liver tumors and complications such as cardiac or other anomalies, but portosystemic encephalopathy and gastrointestinal bleeding occur only occasionally. The clinical problems differ for each individual with CEPS, and establishing a prognosis can be very difficult.
  
  
  METHODS
  We reviewed the clinical features of 136 reported cases of CEPS and classified these cases according to their portosystemic shunts.
  
  
  RESULTS
  We classified portal blood flow directly into the inferior vena cava (IVC) as type A (88 cases), portal blood flow into the renal vein as type B (36 cases), and portal blood flow into the iliac vein via an inferior mesenteric vein as type C (12 cases). Type A patients were complicated with cardiac anomalies at a higher rate than other types. Type C patients had lower prevalences of cardiac anomalies and portosystemic encephalopathy than the other types, but the prevalence of gastrointestinal bleeding was significantly higher (P < 0.0001). The prognosis of CEPS has improved, and only six deaths have been previously reported, all of which occurred in type A patients.
  
  
  CONCLUSIONS
  We reviewed the previously reported cases of CEPS. Classification according to the portosystemic shunt system might be useful for investigating the clinical features of CEPS.
authors.affiliation: Gastroenterology Division, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Tetsu
authors.initials: T
authors.lastname: Niwa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima