When should paediatric surgeons be vigilant for portosystemic shunts?
- IFALD with established cirrhosis
- Conditions associated with hepatic vein or IVC occlusion:
- Exomphalos with interrupted IVC
- Budd Chiari syndrome / Hepatic vein occlusion e.g. due to thrombus
- Chemotherapy related toxicity
- Malignancy e.g. metastatic Wilms, neuroblastoma with inferior vena cava syndrome
- Vascular malformations e.g. congenital portosystemic shunt
These can be significant during vascular access, or create potential bleeding risks during abdominal surgery.
Where can the portosystemic shunts form?
- Oesophagus: Oesophageal and Para oesophageal
- Stomach: Coronary, Retrogastric and Gastrorenal
- Spleen: Perisplenic, Splenorenal
- Kidney: Splenorenal
- Liver: Umbilical
- Bowel: Mesenteric and Haemorrhoidal
- Retroperitoneal: Paravertebral
- Abdominal wall : Caput medusae