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Introduction: Portal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation as the second therapeutic option after meso-Rex bypass (surgical shunt)., Aim: Analyse the diagnostic profitability of non-invasive scales in order to predict the risk of oesophageal varices (OV) in children with PVT., Material and Methods: Descriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included. There were divided according to the presence of OV and sex, cause, age, previous gastrointestinal bleeding or treatments, results of UGE and scales (Clinical Prediction Rule - CPR), Varices Prediction Rule - VPR), King's Variceal Prediction Score - K-VaPS) and Platelet count/Spleen diameter Ratio - PSR). Qualitative variables were expressed as absolute frequency and percentage, and quantitative variables as median and interquartile range. U Mann-Whitney and Hanley-McNeil tests were used for comparisons., Results: Forty-five UGE were analysed. 80% (n=36) presented OV: median of 3 (2-3) and 33.3% (n=12) required endoscopic variceal ligation. Statistical differences were demonstrated between both groups: CPR (142.39 [132.22-166.53] vs. 122.75 [115.24-133.15]; p=0.003), VPR (9.91 [9.36-11.75] vs. 5.6 [3.34-8.39]; p=0.001), K-VaPS (117.86 [99.66-126.58] vs. 99.64 [94.88-10.18]; p=0.019), PSR (2384.62 [1902.22-3201.63] vs. 1252.5 [579.6-2144.42]; p=0.05), with and area under the curve AUROC>75%, without statistical differences between scales., Conclusions: In paediatric patients with non-cirrotic PVT non-invasive scales can be used as a tool to predict the presence of OV and raise the indication of UGE., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Portal and mesenteric vein thrombosis is a very uncommon complication of laparoscopic surgery, especially after anti-reflux procedures. We report the case of a twenty-year-old man with a history of alcohol and cocaine consumption. A Nissen fundoplication was performed. The patient received a single 20-mg dose of enoxaparin (Clexane®, Aventis Pharma, Spain) two hours before surgery for antithrombotic prophylaxis. On the seventh postoperative day the patient had a portal and mesenteric venous thrombosis, which was confirmed at laparotomy, with both extensive small-intestine necrosis and partial colon necrosis. Despite anticoagulant therapy, the patient died 24 hours later. Surgical findings were confirmed at necropsy. Portal and mesenteric venous thrombosis is an uncommon but severe and even fatal complication after laparoscopic anti-reflux surgery. When other pro-thrombotic, predisposing conditions such as laparoscopic surgery and cocaine consumption are present, the usual prophylactic doses of low molecular weight heparin might not be sufficient to protect against this life-threatening complication.La trombosis venosa mesentérica y portal es una complicación infrecuente de la cirugía laparoscópica. Presentamos el caso de un varón de 20 años, consumidor de cocaína inhalada, al que se realiza una funduplicatura de Nissen laparoscópica, administrándose 20 mg de enoxaparina (Clexane® , Aventis Pharma, Spain) preoperatoriamente. El séptimo día postoperatorio, el paciente presenta una trombosis venosa mesentérica y portal, que se confirma en la laparotomía, con necrosis de todo el intestino delgado y segmentaria del colon, falleciendo el paciente a las 24 horas, a pesar de la terapia anticoagulante y confirmándose el diagnóstico en la necropsia. La trombosis mesentérica y portal es una complicación infrecuentre, pero grave y potencialmente mortal, de la cirugía laparoscópica del reflujo gastroesofágico. Cuando se asocian varios factores predisponentes con un potencial trombótico demostrado aislado, como la cirugía laparoscópica y el consumo de cocaína, no parece que las dosis habituales de profilaxis tromboembólica sean suficientes para evitar esta grave complicación.