title: Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center.
abstract: BACKGROUND
  Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding.
  
  
  OBJECTIVE
  To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension.
  
  
  METHODS
  This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound.
  
  
  RESULTS
  Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding.
  
  
  CONCLUSIONS
  The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality.
authors.affiliation: Departamento de Gastroenterologia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil. pmferri.liu@gmail.com
authors.forename: Priscila Menezes
authors.initials: PM
authors.lastname: Ferri
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Ferreira
authors.forename: Eleonora Druve Tavares
authors.initials: ED
authors.lastname: Fagundes
authors.forename: Shinfay Maximilian
authors.initials: SM
authors.lastname: Liu
authors.forename: Mariza Leitão Valadares
authors.initials: ML
authors.lastname: Roquete
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Penna
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D011169:Portal Vein; D012307:Risk Factors; D015911:Sclerotherapy; D013163:Splenomegaly / Q000209:etiology* / Q000628:therapy; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy