title: Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: our experience.
abstract: BACKGROUND
  In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief.
  
  
  METHODS
  Splenic infarcts were graded as mild, moderate and severe according to the pre-operative CT portogram. Mild, moderate and severe infarcts were defined as an infarct involving < 25%, 25-50% and > 50% area of the spleen, respectively. Mild and moderate infarcts were managed by spleen-preserving distal splenorenal shunt while those with extensive infarcts were subjected to splenectomy and proximal splenorenal shunt. Those with spleen-preserving shunts were closely followed in the post-operative period according to a uniform protocol. Clinical examination was regularly done to assess the size of the spleen and note the presence of pain, tenderness in the left intercostal space. An ultrasound Doppler was done after 7 days to assess shunt patency while CT portogram was repeated at 6 monthly intervals.
  
  
  RESULTS
  Fourteen cases with splenic infarcts formed the study group. Eight cases had mild infarcts, 3 had moderate infarcts and 3 had severe infarcts. Four underwent proximal splenorenal shunt, and 10 underwent warren's shunt (8 with mild and 2 with moderate infarcts). In 9/10 (90%), spleen could eventually be retained. Spleen completely regressed in them and so did the infarct.
  
  
  CONCLUSIONS
  Spleen-preserving distal splenorenal shunt can be considered as a viable option in the management of cases with mild and carefully selected moderate splenic infarcts.
authors.forename: Arbinder
authors.initials: A
authors.lastname: Kumar
authors.forename: Nitin
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Minu
authors.initials: M
authors.lastname: Bajpai
authors.forename: Shasanka Shekhar
authors.initials: SS
authors.lastname: Panda
mesh_terms: D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D011169:Portal Vein; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013156:Splenectomy; D013159:Splenic Infarction / Q000175:diagnosis / Q000209:etiology*; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler