ABSTRACT
The meso-Rex bypass, for those with extrahepatic portal vein occlusion, effectively cures portal hypertension (PHT) and minimizes or even eliminates its major symptoms by restoring physiologic blood flow to the liver. The introduction of this procedure has created a major shift in the timing of intervention for those patients. Patients with PHT may present with a wide variety of initial symptoms, depending on the underlying diagnosis. Some may be entirely asymptomatic until the first presentation with an upper gastrointestinal hemorrhage (hematemesis and/or melena). The evaluation of a child with PHT starts with laboratory studies that assess the degree of hypersplenism and liver dysfunction. These include a complete blood count, a comprehensive metabolic panel including liver function tests (including albumin and bilirubin), serum ammonia, and a coagulation panel. Abdominal ultrasound with Doppler flow studies of the liver is often obtained but is of very limited usefulness in determining what kind of surgery is possible.
