Portal Hypertension in Infants and Children

Portal hypertension may be defined as a condition which develops in response to obstruction to portal blood flow. This may be caused by thrombosis or abnormalities in the portal vein or its tributaries or by obstruction within the liver itself. The primary clinical manifestations are splenomegaly and hemorrhage from varices. Both develop in direct response to the increased portal pressure. Ascites, although commonly seen in patients with cirrhosis, does not bear as direct a relationship to elevated portal pressure as was formerly believed, developing as a manifestation of hepatic decompensation frequently seen in association with portal hypertension.¹ Although Stahl,²as early as 1748, had observed that the portal vein, the spleen, and hemorrhoids were related in a vaguely described disease syndrome, it was not until the beginning of the present century that the concept of portal hypertension was actually suggested. Preble³presented a well-documented report of 60