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Long term maintenace of transjugular intrahepatic portosystemic shunt in children Case report

Long term maintenace of transjugular intrahepatic portosystemic shunt in children Case report. Young Ju Hong M.D., Seonae Ryu , Hye Kyung Chang M.D., Jung Tak Oh M.D., Seok Joo Han M.D. Department of Pediatric Surgery Severance Children`s Hospital Department of Surgery

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Long term maintenace of transjugular intrahepatic portosystemic shunt in children Case report

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  1. Long term maintenace of transjugularintrahepaticportosystemic shunt in children Case report Young Ju Hong M.D., SeonaeRyu, Hye Kyung Chang M.D., Jung Tak Oh M.D., SeokJoo Han M.D. Department of Pediatric Surgery Severance Children`s Hospital Department of Surgery Yonsei University College of Medicine

  2. Background Transjugularintrahepaticportosystemic shunt(TIPS) • Complications of severe portal hypertension • Endoscopic, pharmacologically failed • Refractory life threatening variceal bleeding • Refractory ascites • Temporary(bridge to transplantation) • Technically demanding procedure

  3. Case – History of illness • F/13Y • Birth History • IUP 40 wks,BW 3.1 kg, NSVD • At 65 days : Kasai operation d/t Biliaryatresia • CMV negative, postoperative jaundice free • At age 3(2003.01) : hematemesis-> beta-blocker start

  4. Case – History of illness • At age 4(2003.05) : hematemesis-> 12,3,10 o`clock sclerotherapy

  5. Case – History of illness • At age 4(2003.06) : melena, hematemesis • 1st TIPS • EGD f/u(7wk) CT f/u(2wks)

  6. Case – History of illness • At age 5 ( 1st TIPS 6개월후: 2003.12) : melena • EGD : esophagus: mild venous dilatation without bleeding stigma stomach: fundus prominent vascular marking without dilatation • Conservative treatment

  7. Case – History of illness • At age 5 (1st TIPS 9개월후:2004.02) : hematemesis • Doppler US / EGD • 2nd TIPS (revision)

  8. Case – History of illness • At age 6 (2nd TIPS 9개월후:2004.12) : hematemesis • Doppler US / EGD • 3rd TIPS (revision)

  9. Case – History of illness • At age 9 (3rd TIPS 56개월후:2009.07) : hematemesis • EGD/CT • Doppler US • 4th TIPS (revision)

  10. Case – History of illness • At age 9 (4th TIPS 2주 ) : drawsy mental status • Laboratory test : T.bil 3.3(2~3) Ammonia 144(70~170) • Brain CT/MRI

  11. Case – History of illness • Now • Age 13 • EGD / doppler US

  12. Conclusion Transjugularintrahepaticportosystemic shunt(TIPS) • feasible • safe • effective in children with portal hypertension unresponsive to endoscopic and medical treatment

  13. Thank you for your attention

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