Portal Vein Thrombosis in Sudanese Children

Background: Portal Vein Thrombosis (PVT) is one of the most common causes of portal hypertension among children in Sudan.Objectives: To determine the incidence, aetiology and mode of presentation of PVT among children and find its relation to gastrointestinal bleeding in a Sudanese hospital.Methodology: This is a prospective hospital based study conducted at a tertiary care paediatric hospital in Khartoum, Sudan (Gaffer Ibn Oaf Specialized Children Hospital (GIO)). 350 children were diagnosed on clinical grounds (heamatemiss, splenomegaly) to have portal hypertension. After laboratory investigations (CBC, LFTs, coagulations profile and RFTs), abdominal sonography with Doppler, 275 patients turned to have portal vein thrombosis. Upper GI endoscopy was done for all patients and liver biopsy when indicated. Data were analysed, discussed and conclusion were reached.Results: Out of 800 children presented with upper GI bleeding 350 were diagnosed as having esophageal varices bleeding due to portal hypertension (44%), out of these 250 (70%) children were found to have PVT as a cause of their portal hypertension, and another 25 children were diagnosed to have PVT without GI bleeding. Their ages ranged between 4 month and 16 years. Two hundred were males. Seventy five were below one year of age. History of risk factor for PVT was found only in 68 children. All the bleeders had sclerotherapy, band ligation or both beside propranolol and H2 blockers or PPI. Time for follow up was between 6 month and 4.5 years. 150 children cleared their varices with 4-6 cession of either sclerotherapy, banding or both, the rest of the children arestill receiving sclerotherapy. Ten children received liver support for portal biliopathy, five children had splenectomy because of hypersplenism. Four children died. Propranolol was stopped in 50 children out of 150 children who cleared their varices after two yearsConclusions: PVT in children is common in Sudanese children, and  represents the second common cause of upper GI bleeding. Its aetiology is obscure in the majority of cases and more studies and facilities are needed to uncover the underlying cause. Simple clinical data,  ultrasonography and upper GI endoscopy are quite adequate measures to reach accurate diagnosis. Combinations of endoscopic sclerotherapy and band ligations with propranolol are very effective in controlling the bleeding of the esophageal varices, though it has a remarkable effect on the qualityof life of affected children. Thus appropriate medical alternative or surgical treatments are needed in order to reduce morbidity and mortality and improve the quality of life of these patients