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Case Reports in Gastrointestinal Medicine
Volume 2013 (2013), Article ID 523154, 3 pages
http://dx.doi.org/10.1155/2013/523154
Case Report

Portal Hypertension in Childhood Bilateral Wilms' Tumor Survivor: An Excellent Indication for TIPS

1Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy
2Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine University of Pavia, 27100 Pavia, Italy
3Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
4Infectious Diseases Department, IRCCS Policlinico San Matteo Foundation and University of Pavia, 27100 Pavia, Italy

Received 13 February 2013; Accepted 17 March 2013

Academic Editors: S. Kikuchi, I. C. Lawrance, and J. Vecht

Copyright © 2013 Ghassan Nakib et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Increased pressure in portal venous system is relatively a rare complication after chemoradiotherapy for Wilms' tumor (WT). In paediatric population, feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension nonresponsive to medical or endoscopic treatment have been recently advocated. We report a case of TIPS positioning in a 15-year-old girl with portal hypertension as a long-term sequel of multimodality therapy in bilateral WT. Case Report. Two-year-old girl was diagnosed for bilateral WT. Right nephrectomy with left heminephrectomy and chemoradiotherapy were performed. At 7 years of age, the first gastrointestinal bleeding appeared, followed by another episode two years later, both were treated successfully with beta-blockers. At 15 years of age, severe unresponsive life-threatening gastroesophageal bleeding without hepatosplenomegaly was managed by TIPS. Reduction of the portosystemic pressure gradient was obtained. Conclusion. TIPS positioning for portal hypertension in long-term tumors' sequel is feasible and could be considered as an additional indication in paediatric patients.