Correlation of splenic volume with hematological parameters, splenic vein diameter, portal pressure and grade of varices in extrahepatic portal vein obstruction in children.
OBJECTIVE
To study the correlation between the volume of the spleen and hematological parameters, splenic vein diameter, portal pressure before shunt, portal pressure after shunt, reduction of portal pressure and grade of esophageal varices in patients with extrahepatic portal vein obstruction (EHPVO).


METHODS
Twenty-four patients with EHPVO who underwent splenectomy with leino-renal shunt during a period of 2 years were prospectively analyzed. Splenic volumes were measured from CT scans using appropriate volumetry software. In order to standardize the difference in the size of the patients, the splenic volume was expressed as a ratio, the splenic volume index, between the actual volume as measured on the CT scan and the surface area of the body. The splenic vein diameter was measured on the CT portogram and confirmed during surgery using a caliper. The grade of esophageal varices was determined during esophageal endoscopy using the Japanese Research Society for Portal Hypertension classification. The portal pressure was measured by cannulating a venous tributary of the gastro-epiploic arcade and using a pressure transducer.


RESULTS
The splenic volume, expressed as splenic volume index, ranged from 362.15 to 1,849.51 ml/m² (mean 929.23 ± 409.02). Larger splenic volumes were associated with lower hemoglobin and platelet counts and significantly lower total leukocyte counts (p = 0.0003). The portal pressures reduced remarkably following the splenectomy and leino-renal shunt; mean post-shunt pressure 20 ± 6.63 mmHg from mean pre-shunt pressure of 34.33 ± 6.21 mmHg (mean percentage reduction 43.37 ± 16.02%). There was no statistically significant correlation between splenic volume and any of the hemodynamic parameters except a weak correlation with splenic vein diameter. There was no correlation between the splenic vein diameter and the pre-shunt portal pressure; however, there was a statistically significant correlation between the splenic vein diameter and the percentage of post-shunt portal pressure reduction (p = 0.0494).


CONCLUSIONS
Splenic volume has a weak correlation with splenic vein diameter, but does not correlate with portal pressure or the grade of varix. Splenic vein diameter has a statistically significant correlation with the percentage of portal pressure reduction following a leino-renal shunt. There is a statistically significant negative correlation between the splenic volume and the total leukocyte count.
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
Irom Keshorjit
IK
Singh
V
V
Bhatnagar
A K
AK
Gupta
A
A
Seith
D002648:Child; D004932:Esophageal and Gastric Varices / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D007958:Leukocyte Count; D008297:Male; D009929:Organ Size; D017082:Portal Pressure / Q000502:physiology*; D011169:Portal Vein / Q000473:pathology*; D011446:Prospective Studies; D013154:Spleen / Q000473:pathology*; D013162:Splenic Vein / Q000473:pathology*; D013163:Splenomegaly
J Pediatr. 1983 Nov;103(5):696-702
6605419
J Clin Ultrasound. 2001 Jan;29(1):7-13
11180179
Arch Intern Med. 1985 Apr;145(4):651-4
3985728
Ann Surg. 1970 Apr;171(4):522-6
5460594
J Pediatr Surg. 1994 Feb;29(2):142-51; discussion 151-4
8176584
Digestion. 1978;17(1):63-8
304821
Clin Physiol. 1985 Dec;5(6):531-9
4092413
World J Gastroenterol. 2005 Aug 7;11(29):4560-5
16052688
J Gastroenterol Hepatol. 2003 Feb;18(2):185-9
12542604
Hepatology. 1985 May-Jun;5(3):419-24
3873388
Q J Med. 1979 Oct;48(192):627-39
538223
Indian J Gastroenterol. 1994 Jan;13(1):1-4
8119742
Am J Gastroenterol. 1989 Apr;84(4):403-8
2929561
Am J Gastroenterol. 1996 Dec;91(12):2580-3
8946990
Dig Dis Sci. 1992 Mar;37(3):335-9
1735355
J Gastroenterol Hepatol. 1996 Oct;11(10):903-7
8912124
Gastroenterology. 1980 Dec;79(6):1139-44
6969201
J Pediatr Surg. 1978 Feb;13(1):51-7
305475
Hepatogastroenterology. 1994 Dec;41(6):573-7
7721248
Arq Gastroenterol. 2004 Jul-Sep;41(3):150-4
15678198
Jpn J Surg. 1980 Mar;10(1):84-7
7373958
J Pediatr Gastroenterol Nutr. 1990 May;10(4):430-4
2358974