Portal hypertension and hypersplenism in extrahepatic portal venous obstruction: Are they related?
- 68 Downloads
Background and Aims
Portal hypertension (PHT) due to extrahepatic portal venous obstruction (EHPVO) is common in developing countries. Hypersplenism is a near-constant feature of EHPVO, but its significance, unlike in cirrhotics, is unknown. We aimed to study the relationship between hypersplenism and the severity of PHT in patients with EHPVO.
This prospective study was done at a tertiary care center from January 2014 to August 2015. All patients with EHPVO who underwent a splenectomy and a shunt or devascularization were included. Data regarding clinical profile, preoperative parameters, and intraoperative details were recorded. The correlation was studied between hypersplenism and the intraoperatively measured portal pressures and markers of PHT.
Of the 40 patients studied (mean [SD] age 22.4 [8.4] years), hematological hypersplenism was present in 39 (97.5%). The mean (SD) hemoglobin, total leukocyte counts (TLC), and platelet counts were 9.9 (2.4) g/dL, 2971 (1239) cells/mm3, and 66,400 (32047) cells/mm3, respectively. The mean (SD) sonographic spleen volume (SV), splenic weight, and intraoperative portal pressure were 1084.7 (553.9) cm3, 1088.7 (454.7) g, and 35.6 (5.1) mmHg, respectively. The TLC and platelet counts correlated inversely with the portal pressure. Additionally, the platelet counts correlated negatively with eradicated variceal status, SV, and weight; hemoglobin with SV and weight; and TLC with SV. Multivariate analysis showed the platelet counts were an independent predictor of portal pressures and platelet counts ≤ 53,500 cells/mm3 indicated significantly high portal pressures.
The platelet counts showed a significant inverse correlation with portal pressures in patients with EHPVO and may be used as surrogate markers of PHT. A platelet count ≤ 53,500 cells/mm3 is predictive of significantly high pressures.
RK, ANS, SP: conception and design of this work; RK, KSM, RS, S: acquisition of data; RK, ANS, SP, NRD, PS: analysis and interpretation of data. All authors have contributed to drafting this work or revising it critically for important intellectual content. All authors also approve the manuscript in its current form for publication and agree to be accountable for all aspects of the work and to ensure that questions related to the accuracy or integrity of any part of this work will be appropriately investigated and resolved.
Compliance with ethical standards
Conflict of interest
RK, ANS, KSM, SP, RS, S, NRD, and PS declare that they have no conflicts of interest.
The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown in Springer.com.
The study was approved by the institutional ethics committee.
No financial support obtained for the study.
List grant support and other assistance
- 2.Sarin SK, Sollano JD, Chawla YK, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int. 2006;26:512–9.Google Scholar
- 3.Basu A. Surgical management of juvenile portal hypertension. Proc. 37th Int. Paediatr. Congr. 1977, New Delhi, India; 1977.Google Scholar
- 8.Lee E, Kim YJ, Goo DE, et al. Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices. World J Gastroenterol. 2016;22:3212–9.Google Scholar
- 9.Silkauskaite V, Pranculis A, Mitraite D, Jonaitis L, Petrenkiene V, Kupcinskas L. Hepatic venous pressure gradient measurement in patients with liver cirrhosis: a correlation with disease severity and variceal bleeding. Med Kaunas Lith. 2009;45:8–13.Google Scholar
- 10.Piscaglia F, Donati G, Cecilioni L, et al. Influence of the spleen on portal haemodynamics: a non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders. Scand J Gastroenterol. 2002;37:1220–7.Google Scholar
- 11.Alcantara RV, Yamada RM, De Tommaso AMA, Bellomo-Brandão MA, Hessel G. Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction. J Pediatr 2012;88:341–6.Google Scholar
- 19.Weiss B, Shteyer E, Vivante A, et al. Etiology and long-term outcome of extrahepatic portal vein obstruction in children. World J Gastroenterol. 2010;16:4968–72.Google Scholar
- 23.Rajalingam R, Javed A, Sharma D, et al. Management of hypersplenism in non-cirrhotic portal hypertension: a surgical series. Hepatobiliary Pancreat Dis Int. 2012;11:165–71.Google Scholar
- 24.Mitra SK, Kumar V, Datta DV, et al. Extrahepatic portal hypertension: a review of 70 cases. J Pediatr Surg. 1978;13:51–7.Google Scholar