Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1984 Apr;59(4):336–340. doi: 10.1136/adc.59.4.336

Bleeding oesophageal varices with long term follow up.

R A Spence, G W Johnston, G W Odling-Smee, H W Rodgers
PMCID: PMC1628661  PMID: 6609683

Abstract

Complete long term follow up was obtained in 27 children who had bled from oesophageal varices. Most presented with haematemesis or melaena at an average age of 5.2 years in the portal vein thrombosis group (20 children) and 9.5 years in the intrahepatic group (7 children). All had splenomegaly. Only 6 of 20 children with portal vein thrombosis had a possible precipitating factor. A total of 182 admissions for bleeding are reported, in 68 of which injection sclerotherapy was used to control bleeding. Control rate with injection sclerotherapy was 97%. Shunts performed below age 10 years were associated with a high thrombosis rate. A conservative approach to bleeding varices in children is recommended with transfusion, pitressin, and injection sclerotherapy. Oesophageal transection may have a role in the emergency management of the few children in whom bleeding is not controlled by injection sclerotherapy.

Full text

PDF
337

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ARCARI F. A., LYNN H. B. Bleeding esophageal varices in children. Surg Gynecol Obstet. 1961 Jan;112:101–105. [PubMed] [Google Scholar]
  2. Bismuth H., Franco D., Alagille D. Portal diversion for portal hypertension in children. The first ninety patients. Ann Surg. 1980 Jul;192(1):18–24. doi: 10.1097/00000658-198007000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. FEARON B., SASS-KORTSAK A. The management of esophageal varices in children by injection of sclerosing agents. Ann Otol Rhinol Laryngol. 1959 Sep;68:906–915. doi: 10.1177/000348945906800323. [DOI] [PubMed] [Google Scholar]
  4. FOSTER J. H., HOLCOMB G. W., KIRTLEY J. A. Results of surgical treatment of portal hypertension in children. Ann Surg. 1963 Jun;157:868–880. doi: 10.1097/00000658-196306000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. FOSTER J. H., SAWYERS J. L., SCOTT H. M., Jr MANAGEMENT OF PORTAL HYPERTENSION IN CHILDREN. Bull Soc Int Chir. 1964 Jul-Aug;23:398–409. [PubMed] [Google Scholar]
  6. Fonkalsrud E. W., Myers N. A., Robinson M. J. Management of extrahepatic portal hypertension in children. Ann Surg. 1974 Oct;180(4):487–493. doi: 10.1097/00000658-197410000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fonkalsrud E. W. Surgical management of portal hypertension in childhood: long-term results. Arch Surg. 1980 Sep;115(9):1042–1045. doi: 10.1001/archsurg.1980.01380090022006. [DOI] [PubMed] [Google Scholar]
  8. HSIA D. Y. Y., GELLIS S. S. Portal hypertension in infants and children. AMA Am J Dis Child. 1955 Sep;90(3):290–291. doi: 10.1001/archpedi.1955.04030010292011. [DOI] [PubMed] [Google Scholar]
  9. Johnston G. W., Kelly J. M. Early experience with the Boerema button for bleeding oesophageal varices. Br J Surg. 1976 Feb;63(2):117–121. doi: 10.1002/bjs.1800630207. [DOI] [PubMed] [Google Scholar]
  10. Johnston G. W., Rodgers H. W. A review of 15 years' experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg. 1973 Oct;60(10):797–800. doi: 10.1002/bjs.1800601011. [DOI] [PubMed] [Google Scholar]
  11. Johnston G. W. Six years' experience of oesophageal transection for oesophageal varices, using a circular stapling gun. Gut. 1982 Sep;23(9):770–773. doi: 10.1136/gut.23.9.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Keighley M. R., Girdwood R. W., Wooler G. H., Ionescu M. I. Long-term results of surgical treatment for bleeding oesophageal varices in children with portal hypertension. Br J Surg. 1973 Aug;60(8):641–646. doi: 10.1002/bjs.1800600816. [DOI] [PubMed] [Google Scholar]
  13. Lilly J. R. Endoscopic sclerosis of esophageal varices in children. Surg Gynecol Obstet. 1981 Apr;152(4):513–514. [PubMed] [Google Scholar]
  14. Mikkelsen W. P. Extrahepatic portal hypertension in children. Am J Surg. 1966 Mar;111(3):333–340. doi: 10.1016/s0002-9610(66)80008-9. [DOI] [PubMed] [Google Scholar]
  15. O'Brien J. R. Effects of salicylates on human platelets. Lancet. 1968 Apr 13;1(7546):779–783. doi: 10.1016/s0140-6736(68)92228-9. [DOI] [PubMed] [Google Scholar]
  16. Odièvre M., Pigé G., Alagille D. Congenital abnormalities associated with extrahepatic portal hypertension. Arch Dis Child. 1977 May;52(5):383–385. doi: 10.1136/adc.52.5.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Pinkerton J. A., Holcomb G. W., Jr, Foster J. H. Portal hypertension in childhood. Ann Surg. 1972 Jun;175(6):870–886. doi: 10.1097/00000658-197206010-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. SHALDON S., SHERLOCK S. Obstruction to the extrahepatic portal system in childhood. Lancet. 1962 Jan 13;1(7220):63–68. doi: 10.1016/s0140-6736(62)91717-8. [DOI] [PubMed] [Google Scholar]
  19. Stamatakis J. D., Howard E. R., Psacharopoulos H. T., Mowat A. P. Injection sclerotherapy for oesophageal varices in children. Br J Surg. 1982 Feb;69(2):74–75. doi: 10.1002/bjs.1800690205. [DOI] [PubMed] [Google Scholar]
  20. TRUSLER G. A., MORRIS F. R., MUSTARD W. T. Portal hypertension in childhood. Surgery. 1962 Oct;52:664–670. [PubMed] [Google Scholar]
  21. Voorhees A. B., Jr, Chaitman E., Schneider S., Nicholson J. F., Kornfeld S., Price J. B., Jr Portal-systemic encephalopathy in the noncirrhotic patient. Effect of portal-systemic shunting. Arch Surg. 1973 Nov;107(5):659–663. doi: 10.1001/archsurg.1973.01350230017005. [DOI] [PubMed] [Google Scholar]
  22. WALKER R. M. Treatment of portal hypertension in children. Proc R Soc Med. 1962 Sep;55:770–772. [PubMed] [Google Scholar]
  23. Webb L. J., Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. 1979 Oct;48(192):627–639. [PubMed] [Google Scholar]
  24. Wilson K. W., Robinson D. C., Hacking P. M. Portal hypertension in childhood. Br J Surg. 1969 Jan;56(1):13–22. doi: 10.1002/bjs.1800560105. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES