No child ever developed encephalopathy. All these are commonly seen in children from poorer sections of society. Most of these children present with recurrent episodes of massive upper GI bleed, the first usually occurring before the age of 10 years. Although almost all these patients tolerate the bleeding episode well, some children, especially below the age of 5, may develop transient ascites soon after a bleed. Most have a moderate spleno-megaly, although in some the spleen may reach the umbilicus.
Some children present with repeated epistaxis and on evaluation are found to have hypersplenism.
It is in the prevention of recurrence of such bleeds that controversy exists and opinion is divided between endoscopic management on one side and surgery with or without splenectomy on the other. There has been no operative mortality and the one time procedure has at the same time dealt with the problem of hypersplenism. Compared to these results, a study from Institute of Post Graduate Medical Education and Research, Calcutta, has reported the outcome of sclerotherapy in 45 children. The number of sittings of sclerotherapy required for obliteration of varices was 5.9 1.6. Protagonists of the endoscopic procedures and SSLR shunt are keen on splenic pre-servation, but hypersplenism with a bulky painful spleen in a child has its own morbidity besides the chance of accidental rupture.