Non bleeding manifestations in children with extrahepatic portalvein obstruction


  • Karthikeyan P. Department of Pediatrics, SRM Medical college Hospital and Research centre, Kattankulathur, Chennai, Tamil Nadu, India
  • Sumathi B. Department of Pediatrics, ICH, Chennai, Tamil Nadu, India
  • Nirmala D. Department of Pediatrics, ICH, Chennai, Tamil Nadu, India
  • Bhaskar Raju Department of Pediatrics, ICH, Chennai, Tamil Nadu, India
  • Nedunchelian K. Department of Pediatrics, ICH, Chennai, Tamil Nadu, India
  • Sekar P. Department of Pediatrics, SRM Medical college Hospital and Research centre, Kattankulathur, Chennai, Tamil Nadu, India



EHPVO, Non-bleeding manifestations


Background: Extra hepatic portal venous obstruction is the commonest type of portal hypertension (EHPVO) in children, apart from variceal bleeding.  Other features include anemia, hypersplenism, protein losing enteropathy, growth retardation and portal biliopathy. The main objective is to study the bleeding and non-bleeding manifestations in South Indian children with EHPVO

Methods: A prospective descriptive study on children from 1-12 years of age with (EHPVO) from a tertiary care pediatric centre in Chennai, India. Study period was for one year. Children with EHPVO were recruited based on clinical features, USG abdomen findings, liver function tests with or without varices on upper GI endoscopy. They were divided into 2 groups; Bleeders (group 1) and non-bleeders (group 2). Statistical Analysis used was Chi square test and Student t test.

Results: There were 48 children with male, female ratio of 0.9:1. History of umbilical sepsis was present in 20.8%.   Recurrent variceal bleed was the common presentation seen in the majority (83.3%) more so in   rural children between 5-15 years (p- 0.025). Non - bleeding manifestations observed were splenomegaly (95.8%), hypersplenism (37.5%) as age advances (p-0.038), anemia (91.6%), ascites (10.4%), and epistaxis (6.25), growth retardation less than 3rd centile (22.7%). Associated comorbid conditions include insulin dependent diabetes mellitus (4%), atrial septal defect (2%).

Conclusions: Upper GI bleeding was the common presentation in majority of  children between 5-15 years in group 1 and in group II  hypersplenism (37.8%), anemia ( 91.6%) 2 were common. Deranged liver function was noted in 10.4% and growth retardation in 22.7%. One should look for associated congenital anomalies though rare in children. 


Pande GK, Sahni P, Nundy SJ. Gastroenterol Hepatol. 1988,3:99-107.

Arora NK, Lodha R, Gulati S, Gupta AK, Mathur P, Joshi MS et al. Portal hypertension in North Indian children. Indian J Pediatr. 1988,65:585-91.

Thapa BR, Metha S. Endoscopic sclerotherapy of esophageal varices in infants and children. J Pediatr Gastroenterol Nutr. 1990:10:4430-4.

Mitra SK, Kumar V, Dutta DV, Rao PN, Sandhu K, Singh GK. Extrahephatic portal venous obstruction:A review of 70 cases. J Pediatr surg. 1978;13(1):51-4.

Sarin K, Agarwal SR. Extrahephatic portal venous obstruction: Sem Liver Dis. 2002;22(1):43-58.

Sarin SK, Bansal A, Sasan S, Nigam A. Portal vein obstruction in children leads to growth retardation. Hepatology. 1992,15(2):229-33.

Poddar U, Thapa BR, Rao KL, Singh K. Etiologyical spectrum of Oesophageal varices due to portal hypertension in Indian children. J Gastroenterol hepatol. 2008;23(9):1354-7.

Shah SR, Mathur SK. Presentation and natural history of variceal bleeding in patients with portal hypertension due to extrahepatic portal venous obstruction. Indian J Gasteroenterol. 2003;22(6):217-20.

Rangari M, Gupta R, Jain M, Malhotra V, Sarin SK. Hepatic dysfunction in patients with Extrahephatic portal venous obstruction. Liver international. 2003:23(6):434-9.

Webb LJ, Sherlock S. The etiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. 1979;192:627–39.

Khuroo MS, Yattoo GN, Zargar SA, Javid G, Dar MY, Khan BA et al. Biliary abnormalities associated with Extrahephatic portal venous obstruction.Hepatology. 1993:17;807-13.

Alexander J, Desai N, Mishra P, Thakur B, Shimpi L, Sawant P. Type 1 diabetes mellitus and Extrahepatic portal venous obstruction. Trop Gastroenterol. 2004;25(3);139-40.

Odievre M, Pige G, Alagille D. Congenital abnormalities associated with Extrahephatic portal venous obstruction in children. Arch Dis Child. 1977,52:383-5.






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