The Diagnosis of Operable Portal Obstruction in Children

The development of surgical procedures which can modify the course of disease associated with portal hypertension has made early recognition and accurate diagnosis of this condition imperative. This applies in particular to the pediatric age group. In many cases found in infants and children such complications as hemorrhage from esophageal varices and pathological depression of erythrocyte, leucocyte, and platelet levels due to hypersplenism can be avoided by appropriate treatment. Accurate diagnosis of the cause of portal hypertension including the site of portal obstruction is necessary not only to define clearly the indications for surgery, but also to plan the most appropriate procedure.

Several extensive anatomical investigations of the portal venous system have been made recently because of the renewed interest in portal decompression in the treatment of portal hypertension.¹ A compilation of the most frequently encountered patterns in the disssections of 92 specimens by Douglass, Baggenstoss, and Hollinshead²