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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for swollen spleen and splenic vein thrombosis in a 3year old

my little girl is 3 years old and she has had test done over the last 4 months but the doctor will not give any staight answers so I was hoping you could help.She has a swollen spleen. the ultrasound had these findings There is cavernous transformation of the portal vein with 2 primary portal veins in the porta heptis. Marked narrowing of the splenic vein at the juction with the recanalized portal venous collaterals is present surggesting also prior splenic vein thrombosis. There are numerous collateral vesels including portal, esophageal, spleenorenal, mesenteric, gastric and pancreaticoduodenal venous channels. Marked splenomegaly measures approximately 13.6 cm in the longitudinal dimension. The internal architecture enhances homogeneously. The left kidney is compressed.No other abnomality of the kidneys is identified. the liver is not appreciably enlarged and has smooth contours. The pancreas and adrenal are normal. The doctor only would state that we needed to come back in another 9 weeks. Is there anything you can tell me to under stand what is needed for her or what to expect. thanks
Fri, 1 Feb 2019
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Pediatrician 's  Response

Sorry to hear that your daughter has some issues related to spleen.

From the history, what I could infer is that she has features of extrahepatic portal venous obstruction. It's not so uncommon in children. Sometimes there can be inciting factors such as umbilical sepsis or catheter insertion during newborn period but most of the time cause is unknown.

Usually these children can develop following issues
1. Bloody vomiting due to increased pressure in the abdominal blood vessels and collateral formation
2. Low hemoglobin (Anemia) or Thrombocytopenia (low platelets) due to enlarged spleen
3. Splenic injury during contact sport or fall.

If it is extra hepatic portal venous obstruction, your child needs regular Endoscopy and follow up with pediatric gastroenterologist. If any massive bleed is there, it needs to be addressed immediately.

on the long term, surgery like shunts (splenic renal) can be done to reduce the pressure in the abdominal blood vessels.

Rarely splenectomy is indicated. Management based on the symptoms and it varies with individuals. I would suggest you to follow up with a pediatric gastroenterologist for further care.

Hope I have answered your query. Let me know if I can assist you further.

Dr. Nirubhan Bharathy, Pediatrician
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