• pediatric liver transplant;
  • portal hypertension;
  • gastrointestinal bleeding;
  • obscure bleeding;
  • Roux en Y varices

Chu J, Kerkar N, Miloh TA, Rodriguez-Laiz G, Lewis B, Stangl A, Newton KP, Iyer K, Arnon R. Roux-en-Y loop varices in children with portal hypertension after liver transplantation: An unusual cause of “obscure” gastro intestinal bleeding. Pediatr Transplantation 2011: 15: E156–E161. © 2010 John Wiley & Sons A/S.

Abstract:  PHALT may result from graft dysfunction, portal vein thrombosis, arterio-venous fistulas and can lead to GIB, commonly from bleeding esophageal varices. We present three children with GIB requiring multiple blood transfusions that were diagnosed with RY Loop bleeding. Routine EGD, colonoscopy, and CE failed to reveal the bleeding source. However, enteroscopy revealed large varices at the site of hepaticojejunostomy anastomosis in all. Our experience demonstrates that RY loop varices in children with PHALT are a rare and treatable cause of obscure GI bleeding.