We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Surgical Therapy for Gastrointestinal Hemorrhage in Portal Hypertension∗.
- Authors
Rousselot, Louis M.
- Abstract
1. Gastrointestinal hemorrhage in portal hypertension is a serious symptom. When enteric bleeding has once become clinically manifest, it will, if unchecked, result in a fatal outcome in the majority of cases. 2. Two unusual types of intrahepatic block are described--hepatic vein thrombosis, and chronic vasospasm of the "sphinter mechanism" in the hepatic veins. These lesions may produce portal hypertension and esophageal bleeding. Such cases are confusing to the surgeon because the liver appears grossly normal and the basic lesion is not demonstrable at laparotomy. 3. A rational surgical approach to the problem considered in this paper must include two desirata--(1) The control of portal hypertension and recurring bleeding, and, (2) the correction of the hypersplenism and its attendant blood changes by splenectomy. In an attempt to achieve this, the author advocates combined splenectomy and splenorenal shunt, or splenectomy alone for splenic vein obstruction. Local extirpation of the obstructive lesion is performed when indicated. 4. Other operative procedures are sponsored by certain students of this problem. 5. In a comparatively small series of 13 consecutive splenorenal shunts, no operative fatalities occurred. Twelve of these cases had advanced cirrhosis of the liver. This represents a decline from a previously reported 21.4 per cent mortality rate. A late mortality of 23 per cent occurred in cases followed from 1 to 24 months. The survival group have all been well and have had no recurrence (for the periods stated) of the preoperative symptoms (9 hematemesis, 1 ascites). 6. In the four cases with splenectomy alone there was no operative and no late mortality for the periods stated. Three of these have had no further bleeding. 7. A case of Cruveilhier-Baumgarten syndrome is included in this series. It is believed to be the first case reported in the literature in which a successful splenorenal shunt has been accomplished.
- Subjects
GASTROINTESTINAL hemorrhage; PORTAL vein surgery; PORTAL hypertension; HYPERSPLENISM; LIVER surgery; HEMORRHAGE; THERAPEUTICS
- Publication
American Journal of Gastroenterology (Springer Nature), 1982, Vol 77, Issue 10, p772
- ISSN
0002-9270
- Publication type
Article