[size=20px]A three-week old infant was born at 28 weeks gestation and required umbilical vein catheterization for initial resuscitation. Cranial ultrasound (US) demonstrates a grade 1 intraventricular hemorrhage. The umbilical catheter was removed but abdominal US demonstrates portal vein thrombosis.

 

The most appropriate management of this patient with portal vein thrombosis is

 

A systemic anticoagulation.

 

B interventional radiology directed thrombolysis.

 

C Rex shunt.

 

D splenorenal shunt.

 

E long term sonographic follow-up.[/size]

E

E

correct

 

Neonatal portal vein thrombosis is increasingly recognized. Although occasionally responsible for hepatic necrosis, most neonates remain entirely asymptomatic. Thrombus resolution has been described in 30 to 70% of cases over a period of days to months. The diagnosis is established by Doppler ultrasound examination. In certain cases thrombophilia may be a contributing factor. Other risk factors include umbilical catheterization, exchange transfusion and sepsis.

 

Anticoagulation may be considered, but there is no evidence that such intervention improves time to resolution or decreases likelihood of future portal hypertension. Periodic long term ultrasonographic follow-up is recommended. Neonatal portal vein thrombosis remains an important cause of portal hypertension in the pediatric age group when it typically presents with upper gastrointestinal bleeding. Unfortunately, there are currently no criteria to identify those neonates at risk for the development of this complication. Liver lobe atrophy may occur, but liver function is generally well maintained. Portosystemic shunting is indicated for recurrent gastrointestinal bleeding refractory to endoscopic management. The Rex mesoportal shunt is generally preferred although the Warren distal splenorenal shunt is an appropriate alternative.

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