1. Long term maintenace of transjugular intrahepatic portosystemic shunt in children Case report Young Ju Hong M.D., Seonae Ryu, Hye Kyung Chang M.D., Jung Tak Oh M.D., Seok Joo Han M.D. Department of Pediatric Surgery Severance Children`s Hospital Department of Surgery Yonsei University College of Medicine

2. Background Transjugular intrahepatic portosystemic shunt(TIPS) Complications of severe portal hypertension Endoscopic, pharmacologically failed Refractory life threatening variceal bleeding Refractory ascites Temporary(bridge to transplantation) Technically demanding procedure

3. Case – History of illness F/13Y Birth History IUP 40 wks, BW 3.1 kg, NSVD At 65 days : Kasai operation d/t Biliary atresia CMV negative, postoperative jaundice free At age 3(2003.01) : hematemesis-> beta-blocker start

4. Case – History of illness At age 4(2003.05) : hematemesis-> 12,3,10 o`clock sclerotherapy

5. Case – History of illness At age 4(2003.06) : melena, hematemesis 1 st TIPS EGD f/u(7wk) CT f/u(2wks)

6. Case – History of illness At age 5 ( 1 st TIPS 6 개월후 : 2003.12) : melena EGD : esophagus: mild venous dilatation without bleeding stigma stomach: fundus prominent vascular marking without dilatation Conservative treatment

7. Case – History of illness At age 5 (1 st TIPS 9 개월후 :2004.02) : hematemesis Doppler US / EGD 2 nd TIPS (revision)

8. Case – History of illness At age 6 (2 nd TIPS 9 개월후 :2004.12) : hematemesis Doppler US / EGD 3rd TIPS (revision)

9. Case – History of illness At age 9 (3 rd TIPS 56 개월후 :2009.07) : hematemesis EGD/CT Doppler US 4th TIPS (revision)

10. Case – History of illness At age 9 (4 th TIPS 2 주 ) : drawsy mental status Laboratory test : T.bil 3.3(2~3) Ammonia 144(70~170) Brain CT/MRI

11. Case – History of illness Now Age 13 EGD / doppler US

12. Conclusion Transjugular intrahepatic portosystemic shunt(TIPS) feasible safe effective in children with portal hypertension unresponsive to endoscopic and medical treatment

13. Thank you for your attention