Portal vein thrombosis in children: Unique Risk factors, treatment, Challenges, and outcomes compared to adults

Objectives Portal vein thrombosis (PVT) is an uncommon but clinically important condition in both children and adults. While adult PVT has been better characterized, evidence in children remains limited, and direct pediatric–adult comparative data are scarce. Methods We conducted a retrospective single-center cohort study including children and adults with radiologically confirmed portal vein thrombosis. Clinical characteristics, management strategies, and outcomes were compared across age groups. Results The study included 35 children and 40 adults with radiologically confirmed PVT. Median age at diagnosis was 8 months in children and 54.5 years in adults. Thrombosis was provoked in 40% of children (n=14), most commonly following umbilical venous catheterization (n=11), and in 85% of adults (n=34), most often associated with surgery, cirrhosis or malignancy. Anticoagulation was administered in 77% of children (n=27) and 90% of adults (n=36). Meso-Rex shunt was performed in 31% of children (n=11). Recanalization occurred in 45.7% of children (n=16) and 52.5% of adults (n=21). In adults, recanalization was more frequent among anticoagulated patients than those not receiving anticoagulation (58% vs 20%), whereas in children no clear association with anticoagulation was observed (52% vs 21%). Recurrent thrombosis occurred in 17% of children (n=6) and 13% of adults (n=5); most pediatric recurrences represented shunt thrombosis. Bleeding complications occurred in 31% of children and 30% of adults, most commonly as upper gastrointestinal bleeding. No bleeding-related deaths were observed. Conclusion Pediatric and adult PVT differ in risk factors and presentation. Anticoagulation appeared safe in both groups, with clearer recanalization benefit in adults.