Successful preemptive surgical division of type 2 - congenital extrahepatic portosystemic shunt in children

Purpose : A congenital extrahepatic portosystemic shunt (CEPS) is a rare abnormality. The shunts are classified into 2 types. Of these, a type 2-shunt is a side-to-side one, which may be treated by a simple shunt division. The aim of this retrospective study was to clarify the effects of a surgical shunt division on 4 children with type 2-CEPS. Patients : Between June 2002 and June 2008, 4 children with type 2-CEPS underwent a surgical shunt division. Various clinical factors of each patient, including shunt types, shut ratios evaluated by portal scintigraphy using 123I-iodoamphetamine, serum levels of ammonia and total bile acids before and after surgery were evaluated. Findings : Two children had a conventional open surgery and the other two had a laparoscopic surgery. The serum levels of ammonia as well as total bile acids of these children decreased significantly to the normal levels within a month after the surgical shunt divisions. All the children had a better clinical course. Conclusions : A shunt division, especially by laparoscopic surgery, is an effective therapy for type 2-CEPS. To the best of our knowledge by reviewing literatures, our cases are the youngest ones treated by laparoscopic shunt division

フククウキョウカ ユチャク ハクリジュツゴ サイド イレウス オ ハッショウシ チョウカン セツジョジュツ ガ ヒツヨウ トナッタ ユチャクセイ イレウス ノ イチレイ

A 12-year old boy with a history of surgery for a gastroschisis in the neonatal period had experienced recurrent adhesional ileus. Each condition had been successfully treated by conservative treatments. In June 2008, he was admitted to our hospital again, complaining of abdominal pain. An abdominal X-ray revealed remarkable dilatation of the small intestine. Because of the repeated adhesional ileus, the boy underwent laparoscopic adhesiolysis. Even after the operation, the boy complained of abdominal pain, which indicated that the laparoscopic operation was unsuccessful. We performed a partial resection of the strictured small intestine under open laparotomy. Until this operation, we had never recognized the causative stricture of the small intestine. After the reoperation, the boy had a good clinical course. The number of laparoscopic surgeries has dramatically increased in pediatric cases lately. Adhesional ileus is considered a good indication for this procedure. However, we experienced a failure of laparoscopic adhesiolysis, which made us realize that there are some limitations in this approach