Abstract
Interventional radiology's role in the management of portal hypertension in the pediatric
population differs from the management of adult portal hypertension. In the pediatric
population, portal hypertension is frequently secondary to thrombosis and cavernous
transformation of the extrahepatic portion of the portal vein. Transjugular intrahepatic
portosystemic shunt can be utilized to manage portal hypertension in children with
intrinsic liver disease that results in cirrhosis and portal hypertension, and is
often used as a bridge to transplant. While technically feasible in extrahepatic portal
vein occlusion, the sequelae of portosystemic shunting are less desirable in a child.
The Meso-Rex bypass procedure, which represents the mainstay of management for pediatric
portal hypertension, provides surgical relief of extrahepatic portal vein obstruction
and restores mesenteric venous blood flow to the liver. This article aims to review
management of portal hypertension in children as it pertains to the interventional
radiologist, including preoperative assessment, postoperative evaluation, and the
management of complications of the Meso-Rex bypass.
Keywords
Meso-Rex bypass - Rex shunt - cavernous transformation - portal hypertension - extrahepatic
portal vein obstruction
