Roberto M Yamada1, Gabriel Hessel. 1. Department of Pediatrics, Pediatric Gastroenterologist and Ultrasonographist, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil. r945697@dac.unicamp.br
Abstract
BACKGROUND: Portal vein thrombosis (PVT) is one of the most frequent causes of portal hypertension (PH) during childhood. Portal systemic collateral vessels occur at several locations, including the gallbladder (GB). OBJECTIVE: To evaluate the GB in patients with PVT using US to assess GB wall thickness and its function, and the incidence of lithiasis and varices. MATERIALS AND METHODS: A prospective study was done on 21 children and young adults whose ages ranged from 17 months to 20 years and 10 months (mean age: 11 years and 7 months). A control group was matched for age and sex. All of the patients and controls fasted for at least 6 h prior to the US examination. The GB measurements included anterior wall thickness. These measurements were obtained before the ingestion and then 30 and 60 min after the ingestion of a meal containing at least 25 g of fat. The rate of GB contractility was calculated based on these results. The presence of varices in the GB wall was detected by the characteristic serpentine shape of the intramural vessels and by the venous flow using pulse duplex and color Doppler imaging. The presence of biliary lithiasis was confirmed by shadowing. The chi-square test, the exact Fisher test and the Mann-Whitney test were used to compare the results. RESULTS: Biliary lithiasis occurred in 3 (14.2%) of the 21 patients. The GB wall was thickened in 13 (61.9%) of the 21 patients, which corresponded with the number of patients with GB varices. The wall dimensions of all the controls were within normal limits. In patients with PVT; GB contractility was lower than in the 21 patients used as control and resulted in a significant difference in all of the measurements. CONCLUSION: GB varices are very common in children with PVT, and it is noted especially in patients whose GB wall was thickened and in whom the GB contractility was reduced. Lithiasis could be a consequence of the decreased contractility of GB.
BACKGROUND: Portal vein thrombosis (PVT) is one of the most frequent causes of portal hypertension (PH) during childhood. Portal systemic collateral vessels occur at several locations, including the gallbladder (GB). OBJECTIVE: To evaluate the GB in patients with PVT using US to assess GB wall thickness and its function, and the incidence of lithiasis and varices. MATERIALS AND METHODS: A prospective study was done on 21 children and young adults whose ages ranged from 17 months to 20 years and 10 months (mean age: 11 years and 7 months). A control group was matched for age and sex. All of the patients and controls fasted for at least 6 h prior to the US examination. The GB measurements included anterior wall thickness. These measurements were obtained before the ingestion and then 30 and 60 min after the ingestion of a meal containing at least 25 g of fat. The rate of GB contractility was calculated based on these results. The presence of varices in the GB wall was detected by the characteristic serpentine shape of the intramural vessels and by the venous flow using pulse duplex and color Doppler imaging. The presence of biliary lithiasis was confirmed by shadowing. The chi-square test, the exact Fisher test and the Mann-Whitney test were used to compare the results. RESULTS:Biliary lithiasis occurred in 3 (14.2%) of the 21 patients. The GB wall was thickened in 13 (61.9%) of the 21 patients, which corresponded with the number of patients with GB varices. The wall dimensions of all the controls were within normal limits. In patients with PVT; GB contractility was lower than in the 21 patients used as control and resulted in a significant difference in all of the measurements. CONCLUSION: GB varices are very common in children with PVT, and it is noted especially in patients whose GB wall was thickened and in whom the GB contractility was reduced. Lithiasis could be a consequence of the decreased contractility of GB.