Liver nodules have been reported after portal systemic shunt surgery (PSSS) in animal experiments or in humans with liver cirrhosis. The aim of our study was to assess the incidence of liver nodules after surgery for extrahepatic portal vein obstruction (EHPVO) in children without associated liver disease.
We retrospectively reviewed the charts of 45 children who had surgery from 1979 to 2005 for EHPVO in our institution, consisting of 38 PSSS and 7 portal reperfusion procedures (PRPs). We assessed the presence of liver nodules on ultrasonography.
Of 45 patients, 7 (15%) had liver nodules during a median of 80 months of follow-up. All the nodules occurred after PSSS. Five nodules were subjected to biopsy; we found 2 liver cell adenomas and 3 focal nodular hyperplasias.
In this study, liver nodules occurred in 18% of cases after PSSS for EHPVO in children and not after PRP. As many children have undergone PSSS throughout the world, the presence of liver nodules should be considered during the follow-up of those patients.
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- Portal hypertension: portosystemic shunts.in: Stringer MD Pediatric surgery and urology: long-term outcomes. W.B. Saunders, Philadelphia1998: 439-446
- Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years' experience with portal-systemic shunt.J Am Coll Surg. 2002; 194 ([discussion 728-730]): 717-728
- Risk of gastrointestinal bleeding during adolescence and early adulthood in children with portal vein obstruction.J Pediatr. 2000; 136: 805-808
- Surgery for portal hypertension.in: Arnold Surgery of the liver, bile ducts and pancreas in children. Distributed in the U.S.A. by Oxford University Press, London2002: 315-328
- Recent concepts regarding extra-hepatic portal hypertension.Semin Pediatr Surg. 2005; 14: 216-225
- Mesenterico left portal bypass for variceal bleeding owing to extrahepatic portal hypertension caused by portal vein thrombosis.J Pediatr Surg. 2006; 41: 1259-1263
- Adenomatous hyperplasia of the liver in a patient with congenital hepatic fibrosis.J Hepatol. 1994; 20: 213-217
- Hyperplastic nodules after portacaval anastomosis in rats.Nature. 1976; 264: 440-442
- Les lésions précancereuses sur foie cirrhotique et non cirrhotique.Gastroenterol Clin Biol. 2004; 28: D158-D170
- Hepatic nodular lesions associated with abnormal development of the portal vein.AJR Am J Roentgenol. 2004; 183: 1333-1338
- Multiple hyperplastic nodules in the liver with congenital absence of portal vein: MRI findings.Pediatr Radiol. 2006; 36: 445-448
- Case report: congenital absence of the portal vein associated with nodular hyperplasia in the liver.J Gastroenterol Hepatol. 1997; 12: 639-643
- Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.World J Gastroenterol. 2005; 11: 5691-55695
- Liver cell adenoma with malignant transformation: a case report.World J Gastroenterol. 2003; 9: 2379-2381
- Hepatic adenomas: imaging and pathologic findings.Radiographics. 2001; 21 ([discussion 892-894]): 877-892
- Terminology of nodular hepatocellular lesions. International Working Party.Hepatology. 1995; 22: 983-993
- Vers une nouvelle approche diagnostique des nodules hépatocytaires bénins.Gastroenterol Clin Biol. 2005; 29: 641-644
- Does a portal-systemic shunt increase the risk of primary hepatic carcinoma in cirrhosis of the liver.Scand J Gastroenterol. 1985; 20: 59-64
- Long-term follow-up of portacaval shunt in glycogen storage disease type 1B.Eur J Pediatr. 2000; 159: 268-272
- In vivo and electron microscopic observations of the hepatic microvasculature in the rat following portacaval anastomosis.Hepatology. 1983; 3: 96-104
- Extrahepatic portal vein obstruction results in hepatocyte proliferation but a decrease in protein-C synthesis.J Pediatr Surg. 2007; 42: 796-809
- Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure.Eur J Surg. 1999; 165: 777-781
- Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass.Ann Surg. 2006; 243: 515-521
- Hepatocellular adenoma: MR imaging features with pathologic correlation.AJR Am J Roentgenol. 1995; 165: 303-308
- Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients.Radiology. 2000; 214: 861-868
- Percutaneous liver biopsy in children: impact of ultrasonography and spring-loaded biopsy needles.J Pediatr Gastroenterol Nutr. 2000; 31: 536-539
Accepted: November 3, 2008
Received in revised form: October 7, 2008
Received: June 27, 2008
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.